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Abdelgani S, Khattab A, Adams J, Baskoy G, Brown M, Clarke G, Larvenenko O, DeFronzo RA, Abdul-Ghani M. Empagliflozin Reduces Liver Fat in Individuals With and Without Diabetes. Diabetes Care 2024; 47:668-675. [PMID: 38295394 PMCID: PMC10973912 DOI: 10.2337/dc23-1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE To examine the effect of empagliflozin on liver fat content in individuals with and without type 2 diabetes (T2D) and the relationship between the decrease in liver fat and other metabolic actions of empagliflozin. RESEARCH DESIGN AND METHODS Thirty individuals with T2D and 27 without were randomly assigned to receive in double-blind fashion empagliflozin or matching placebo (2:1 ratio) for 12 weeks. Participants underwent 75-g oral glucose tolerance testing and measurement of liver fat content with MRS before therapy and at study end. Hepatic glucose production before the start of therapy was measured with 3-3H-glucose. RESULTS Empagliflozin caused an absolute reduction of 2.39% ± 0.79% in liver fat content compared with an increase of 0.91% ± 0.64% in participants receiving placebo (P < 0.007 with ANOVA). The decrease in liver fat was comparable in both individuals with diabetes and those without (2.75% ± 0.81% and 1.93% ± 0.78%, respectively; P = NS). The decrease in hepatic fat content caused by empagliflozin was strongly correlated with baseline liver fat content (r = -0.62; P < 0.001), decrease in body weight (r = 0.53; P < 0.001), and improvement in insulin sensitivity (r = -0.51; P < 0.001) but was not related to the decrease in fasting plasma glucose or HbA1c or the increase in hepatic glucose production. CONCLUSIONS Empagliflozin is effective in reducing liver fat content in individuals with and without T2D. The decrease in liver fat content is independent of the decrease in plasma glucose concentration and is strongly related to the decrease in body weight and improvement in insulin sensitivity.
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Affiliation(s)
- Siham Abdelgani
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX
| | - Ahmed Khattab
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX
| | - John Adams
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX
| | - Gozde Baskoy
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX
| | - Marissa Brown
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX
| | - Geoff Clarke
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX
| | - Olga Larvenenko
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX
| | - Ralph A. DeFronzo
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX
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Bergman M, Manco M, Satman I, Chan J, Inês Schmidt M, Sesti G, Vanessa Fiorentino T, Abdul-Ghani M, Jagannathan R, Kumar Thyparambil Aravindakshan P, Gabriel R, Mohan V, Buysschaert M, Bennakhi A, Pascal Kengne A, Dorcely B, Nilsson PM, Tuomi T, Battelino T, Hussain A, Ceriello A, Tuomilehto J. International Diabetes Federation Position Statement on the 1-hour post-load plasma glucose for the diagnosis of intermediate hyperglycaemia and type 2 diabetes. Diabetes Res Clin Pract 2024; 209:111589. [PMID: 38458916 DOI: 10.1016/j.diabres.2024.111589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
Many individuals with intermediate hyperglycaemia (IH), including impaired fasting glycaemia (IFG) and impaired glucose tolerance (IGT), as presently defined, will progress to type 2 diabetes (T2D). There is confirmatory evidence that T2D can be prevented by lifestyle modification and/or medications, in people with IGT diagnosed by 2-h plasma glucose (PG) during a 75-gram oral glucose tolerance test (OGTT). Over the last 40 years, a wealth of epidemiological data has confirmed the superior value of 1-h plasma glucose (PG) over fasting PG (FPG), glycated haemoglobin (HbA1c) and 2-h PG in populations of different ethnicity, sex and age in predicting diabetes and associated complications including death. Given the relentlessly rising prevalence of diabetes, a more sensitive, practical method is needed to detect people with IH and T2D for early prevention or treatment in the often lengthy trajectory to T2D and its complications. The International Diabetes Federation (IDF) Position Statement reviews findings that the 1-h post-load PG ≥ 155 mg/dL (8.6 mmol/L) in people with normal glucose tolerance (NGT) during an OGTT is highly predictive for detecting progression to T2D, micro- and macrovascular complications, obstructive sleep apnoea, cystic fibrosis-related diabetes mellitus, metabolic dysfunction-associated steatotic liver disease, and mortality in individuals with risk factors. The 1-h PG of 209 mg/dL (11.6 mmol/L) is also diagnostic of T2D. Importantly, the 1-h PG cut points for diagnosing IH and T2D can be detected earlier than the recommended 2-h PG thresholds. Taken together, the 1-h PG provides an opportunity to avoid misclassification of glycaemic status if FPG or HbA1c alone are used. The 1-h PG also allows early detection of high-risk people for intervention to prevent progression to T2D which will benefit the sizeable and growing population of individuals at increased risk of T2D. Using a 1-h OGTT, subsequent to screening with a non-laboratory diabetes risk tool, and intervening early will favourably impact the global diabetes epidemic. Health services should consider developing a policy for screening for IH based on local human and technical resources. People with a 1-h PG ≥ 155 mg/dL (8.6 mmol/L) are considered to have IH and should be prescribed lifestyle intervention and referred to a diabetes prevention program. People with a 1-h PG ≥ 209 mg/dL (11.6 mmol/L) are considered to have T2D and should have a repeat test to confirm the diagnosis of T2D and then referred for further evaluation and treatment. The substantive data presented in the Position Statement provides strong evidence for redefining current diagnostic criteria for IH and T2D by adding the 1-h PG.
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Affiliation(s)
- Michael Bergman
- NYU Grossman School of Medicine, Departments of Medicine and of Population Health, Division of Endocrinology, Diabetes and Metabolism, VA New York Harbor Healthcare System, New York, NY, USA.
| | - Melania Manco
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Ilhan Satman
- Istanbul University Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey
| | - Juliana Chan
- The Chinese University of Hong Kong, Faculty of Medicine, Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Hong Kong, China
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, 00189 Rome, Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio Texas, USA
| | - Ram Jagannathan
- Hubert Department of Global Health Rollins, School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Rafael Gabriel
- Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Martin Buysschaert
- Department of Endocrinology and Diabetology, Université Catholique de Louvain, University, Clinic Saint-Luc, Brussels, Belgium
| | - Abdullah Bennakhi
- Dasman Diabetes Institute Office of Regulatory Affairs, Ethics Review Committee, Kuwait
| | - Andre Pascal Kengne
- South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
| | - Brenda Dorcely
- NYU Grossman School of Medicine, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York, NY, USA
| | - Peter M Nilsson
- Department of Clinical Sciences and Lund University Diabetes Centre, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Tiinamaija Tuomi
- Folkhälsan Research Center, Helsinki, Finland; Abdominal Center, Endocrinology, Helsinki University Central Hospital, Research Program for Diabetes and Obesity, Center of Helsinki, Helsinki, Finland
| | | | - Akhtar Hussain
- Faculty of Health Sciences, Nord University, Bodø, Norway; Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Brazil; International Diabetes Federation (IDF), Brussels, Belgium; Diabetes in Asia Study Group, Post Box: 752, Doha-Qatar; Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Jaakko Tuomilehto
- Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain; Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland; Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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Abdelgani S, Khattab A, Adams J, Baskoy G, Triplitt C, DeFronzo RA, Abdul-Ghani M. The impact of increased hepatic glucose production caused by empagliflozin on plasma glucose concentration in individuals with type 2 diabetes and nondiabetic individuals. Diabetes Obes Metab 2024; 26:1033-1039. [PMID: 38131252 DOI: 10.1111/dom.15404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/25/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
AIM To examine the impact of increased hepatic glucose production (HGP) on the decrease in plasma glucose concentration caused by empagliflozin in individuals living with diabetes and in nondiabetic individuals. METHODS A total of 36 individuals living with diabetes and 34 nondiabetic individuals were randomized to receive, in double-blind fashion, empagliflozin or matching placebo in a 2:1 treatment ratio. Following an overnight fast, HGP was measured with 3-3 H-glucose infusion before, at the start of, and 3 months after therapy with empagliflozin. RESULTS On Day 1 of empagliflozin administration, the increase in urinary glucose excretion (UGE) in individuals with normal glucose tolerance was smaller than in those with impaired glucose tolerance and those living with diabetes, and was accompanied by an increase in HGP in all three groups. The amount of glucose returned to the systemic circulation as a result of the increase in HGP was smaller than that excreted by the kidney during the first 3 h after empagliflozin administration, resulting in a decrease in fasting plasma glucose (FPG) concentration. After 3 h, the increase in HGP was in excess of UGE, leading to a small increase in plasma glucose concentration, which reached a new steady state. After 12 weeks, the amount of glucose returned to the circulation due to the empagliflozin-induced increase in HGP was comparable with that excreted by the kidney in all three groups. CONCLUSION The balance between UGE and increase in HGP immediately after sodium-glucose cotransporter-2 (SGLT2) inhibition determined the magnitude of decrease in FPG and the new steady state which was achieved. After 12 weeks, the increase in HGP caused by empagliflozin closely matched the amount of glucose excreted by the kidneys; thus, FPG level remained stable despite the continuous urinary excretion of glucose caused by SGLT2 inhibition.
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Affiliation(s)
- Siham Abdelgani
- Division of Diabetes, University of Texas Health Science Center, and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Ahmed Khattab
- Division of Diabetes, University of Texas Health Science Center, and Texas Diabetes Institute, San Antonio, Texas, USA
| | - John Adams
- Division of Diabetes, University of Texas Health Science Center, and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Gozde Baskoy
- Division of Diabetes, University of Texas Health Science Center, and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Curtis Triplitt
- Division of Diabetes, University of Texas Health Science Center, and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Ralph A DeFronzo
- Division of Diabetes, University of Texas Health Science Center, and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center, and Texas Diabetes Institute, San Antonio, Texas, USA
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Abdul-Ghani M, DeFronzo RA. Fasting Hyperinsulinemia and Obesity: Cause or Effect. J Clin Endocrinol Metab 2023; 108:e1151-e1152. [PMID: 36947093 DOI: 10.1210/clinem/dgad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Ralph A DeFronzo
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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Abu-Farha M, Alatrach M, Abubaker J, Al-Khairi I, Cherian P, Agyin K, Abdelgani S, Norton L, Adams J, Al-Saeed D, Al-Ozairi E, DeFronzo RA, Al-Mulla F, Abdul-Ghani M. Plasma insulin is required for the increase in plasma angiopoietin-like protein 8 in response to nutrient ingestion. Diabetes Metab Res Rev 2023; 39:e3643. [PMID: 36988137 DOI: 10.1002/dmrr.3643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/28/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Plasma levels of angiopoietin-like protein 8 (ANGPTL8) are regulated by feeding and they increase following glucose ingestion. Because both plasma glucose and insulin increase following food ingestion, we aimed to determine whether the increase in plasma insulin and glucose or both are responsible for the increase in ANGPTL8 levels. METHODS ANGPTL8 levels were measured in 30 subjects, 14 with impaired fasting glucose (IFG), and 16 with normal fasting glucose (NFG); the subjects received 75g glucose oral Glucose tolerance test (OGTT), multistep euglycaemic hyperinsulinemic clamp and hyperglycaemic clamp with pancreatic clamp. RESULTS Subjects with IFG had significantly higher ANGPTL8 than NGT subjects during the fasting state (p < 0.05). During the OGTT, plasma ANGPTL8 concentration increased by 62% above the fasting level (p < 0.0001), and the increase above fasting in ANGPTL8 levels was similar in NFG and IFG individuals. During the multistep insulin clamp, there was a dose-dependent increase in plasma ANGPTL8 concentration. During the 2-step hyperglycaemic clamp, the rise in plasma glucose concentration failed to cause any change in the plasma ANGPTL8 concentration from baseline. CONCLUSIONS In response to nutrient ingestion, ANGPTL8 level increased due to increased plasma insulin concentration, not to the rise in plasma glucose. The incremental increase above baseline in plasma ANGLPTL8 during OGTT was comparable between people with normal glucose tolerance and IFG.
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Affiliation(s)
- Mohamed Abu-Farha
- Biochemistry and Molecular Biology Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Mariam Alatrach
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Jehad Abubaker
- Biochemistry and Molecular Biology Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Irina Al-Khairi
- Biochemistry and Molecular Biology Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Preethi Cherian
- Biochemistry and Molecular Biology Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Krisitn Agyin
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Siham Abdelgani
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Luke Norton
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas, USA
| | - John Adams
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas, USA
| | | | | | - Ralph A DeFronzo
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas, USA
| | | | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas, USA
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Abdelgani S, Khattab A, Adams J, Abu-Farha M, Daniele G, Al-Mulla F, Del Prato S, DeFronzo RA, Abdul-Ghani M. Distinct Mechanisms Responsible for the Increase in Glucose Production and Ketone Formation Caused by Empagliflozin in T2DM Patients. Diabetes Care 2023; 46:978-984. [PMID: 36857415 PMCID: PMC10154659 DOI: 10.2337/dc22-0885] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/30/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To examine the mechanisms responsible for the increase in glucose and ketone production caused by empagliflozin in patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS Twelve subjects with T2DM participated in two studies performed in random order. In study 1, endogenous glucose production (EGP) was measured with 8-h infusion of 6,6,D2-glucose. Three hours after the start of 6,6,D2-glucose infusion, subjects ingested 25 mg empagliflozin (n = 8) or placebo (n = 4), and norepinephrine (NE) turnover was measured before and after empagliflozin ingestion with 3H-NE infusion. Study 2 was similar to study 1 but performed under pancreatic clamp conditions. RESULTS When empagliflozin was ingested under fasting conditions, EGP increased by 31% in association with a decrease in plasma glucose (-34 mg/dL) and insulin (-52%) concentrations and increases in plasma glucagon (+19%), free fatty acid (FFA) (+29%), and β-hydroxybutyrate (+48%) concentrations. When empagliflozin was ingested under pancreatic clamp conditions, plasma insulin and glucagon concentrations remained unchanged, and the increase in plasma FFA and ketone concentrations was completely blocked, while the increase in EGP persisted. Total-body NE turnover rate was greater in subjects receiving empagliflozin (+67%) compared with placebo under both fasting and pancreatic clamp conditions. No difference in plasma NE concentration was observed in either study. CONCLUSIONS The decrease in plasma insulin and increase in plasma glucagon concentration caused by empagliflozin is responsible for the increase in plasma FFA concentration and ketone production. The increase in EGP caused by empagliflozin is independent of the change in plasma insulin or glucagon concentrations and is likely explained by the increase in NE turnover.
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Affiliation(s)
- Siham Abdelgani
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX
| | - Ahmed Khattab
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX
| | - John Adams
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX
| | | | - Giuseppe Daniele
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Pisa, Italy
| | | | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Pisa, Italy
| | - Ralph A. DeFronzo
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX
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Al-Ozairi E, Reem AA, El Samad A, Taghadom E, Al-Kandari J, Abdul-Ghani M, Oliver N, Whitcher B, Guess N. A randomised crossover trial: Exploring the dose-response effect of carbohydrate restriction on glycaemia in people with well-controlled type 2 diabetes. J Hum Nutr Diet 2023; 36:51-61. [PMID: 35560850 DOI: 10.1111/jhn.13030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/03/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Trials investigating the role of carbohydrate restriction in the management of glycaemia in type 2 diabetes (T2D) have been confounded by multiple factors, including degree of calorie restriction and dietary protein content, as well as by no clear definition of a low-carbohydrate diet. The present study aimed to provide insight into the relationship between carbohydrate restriction and glycaemia by testing the effect of varying doses of carbohydrate on continuous glucose concentrations within a range of intakes defined as low-carbohydrate at the same time as controlling for confounding factors. METHODS This was a randomised crossover trial in participants with T2D (HbA1c: 6.6 ± 0.6%, 49 ± 0.9 mmol mol-1 ) testing five different 6-day eucaloric dietary treatments with varying carbohydrate content (10%, 15%, 20%, 25%, and 30% kcal). Diets exchanged %kcal from carbohydrate with fat, keeping protein constant at 15% kcal. Daily self-weighing was employed to ensure weight stability throughout each treatment arm. Between dietary treatments, participants underwent a washout period of at least 7 days and were advised to maintain their habitual diet. Glycaemic control was assessed using a continuous glucose monitoring device. RESULTS Twelve participants completed the study. There were no differences in 24-h and post-prandial sensor glucose concentrations between the 30 and 10%kcal doses (7.4 ± 1.1 mmol L-1 vs. 7.6 ± 1.3 mmol L-1 [p = 0.28] and 8.1 ± 1.5 mmol L-1 vs. 8.5 ± 1.4 mmol L-1 [p = 0.28], respectively). In our exploratory analyses, we did not find any dose-response relationship between carbohydrate intake and glycaemia. A small amount of weight loss occurred in each treatment arm (range: 0.4-1.1 kg over the 6 days) but adjusting for these differences did not influence the primary or secondary outcomes. CONCLUSIONS Modest changes in dietary carbohydrate content in the absence of weight loss at the same time as keeping dietary protein intake constant do not appear to influence glucose concentrations in people with well-controlled T2D. SUMMARY This study randomised people with T2D to receive five different doses of carbohydrate from 10% to 30% of calories in random order to see what effect it had on their blood glucose.
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Affiliation(s)
| | | | | | | | | | | | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Brandon Whitcher
- Department of Life Sciences, University of Westminster, London, UK
| | - Nicola Guess
- Dasman Diabetes Institute, Kuwait City, Kuwait.,Department of Life Sciences, University of Westminster, London, UK.,Department of Nutritional Sciences, King's College London, London, UK
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Moody AJ, Molina-Wilkins M, Clarke GD, Merovci A, Solis-Herrera C, Cersosimo E, Chilton RJ, Iozzo P, Gastaldelli A, Abdul-Ghani M, DeFronzo RA. Pioglitazone reduces epicardial fat and improves diastolic function in patients with type 2 diabetes. Diabetes Obes Metab 2023; 25:426-434. [PMID: 36204991 PMCID: PMC9812869 DOI: 10.1111/dom.14885] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 02/02/2023]
Abstract
AIMS To examine the effect of pioglitazone on epicardial (EAT) and paracardial adipose tissue (PAT) and measures of diastolic function and insulin sensitivity in patients with type 2 diabetes mellitus (T2DM). METHODS Twelve patients with T2DM without clinically manifest cardiovascular disease and 12 subjects with normal glucose tolerance (NGT) underwent cardiac magnetic resonance imaging to quantitate EAT and PAT and diastolic function before and after pioglitazone treatment for 24 weeks. Whole-body insulin sensitivity was measured with a euglycaemic insulin clamp and the Matsuda Index (oral glucose tolerance test). RESULTS Pioglitazone reduced glycated haemoglobin by 0.9% (P < 0.05), increased HDL cholesterol by 7% (P < 0.05), reduced triacylglycerol by 42% (P < 0.01) and increased whole-body insulin-stimulated glucose uptake by 71% (P < 0.01) and Matsuda Index by 100% (P < 0.01). In patients with T2DM, EAT (P < 0.01) and PAT (P < 0.01) areas were greater compared with subjects with NGT, and decreased by 9% (P = 0.03) and 9% (P = 0.09), respectively, after pioglitazone treatment. Transmitral E/A flow rate and peak left ventricular flow rate (PLVFR) were reduced in T2DM versus NGT (P < 0.01) and increased following pioglitazone treatment (P < 0.01-0.05). At baseline normalized PLVFR inversely correlated with EAT (r = -0.45, P = 0.03) but not PAT (r = -0.29, P = 0.16). E/A was significantly and inversely correlated with EAT (r = -0.55, P = 0.006) and PAT (r = -0.40, P = 0.05). EAT and PAT were inversely correlated with whole-body insulin-stimulated glucose uptake (r = -0.68, P < 0.001) and with Matsuda Index (r = 0.99, P < 0.002). CONCLUSION Pioglitazone reduced EAT and PAT areas and improved left ventricular (LV) diastolic function in T2DM. EAT and PAT are inversely correlated (PAT less strongly) with LV diastolic function and both EAT and PAT are inversely correlated with measures of insulin sensitivity.
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Affiliation(s)
- Alexander J Moody
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX
| | | | - Geoffrey D Clarke
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX
| | | | | | | | - Robert J Chilton
- Division of Cardiology, UTHSCSA and South Texas Veterans Health Care System, San Antonio, TX
| | - Patricia Iozzo
- Consiglio Nazionale delle Richerche, Pisa, Italy; Diabetes Division, UTHSCSA, Texas
| | - Amalia Gastaldelli
- Consiglio Nazionale delle Richerche, Pisa, Italy; Diabetes Division, UTHSCSA, Texas
| | | | - Ralph A. DeFronzo
- Diabetes Division, UTHSCSA
- Diabetes Institute, and South Texas Veterans Health Care System, San Antonio, TX
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Errafii K, Jayyous A, Arredouani A, Khatib H, Azizi F, Mohammad RM, Abdul-Ghani M, Chikri M. Comprehensive analysis of circulating miRNA expression profiles in insulin resistance and type 2 diabetes in Qatari population. All Life 2022. [DOI: https://doi.org/10.1080/26895293.2022.2033853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Khaoula Errafii
- Biochemistry and Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy of Fez, Sidi Mohammad Ben Abdullah University, Fes, Morocco
- African Genome Center, Mohamed IV Polytechnic, Benguerir, Morocco
- Qatar Biomedical Research Institute, Hamad Ben Khalifa University, HBKU, Doha, Qatar
| | - Amin Jayyous
- Diabetes and Obesity Clinical Research Center, Hamad General Hospital, Doha, Qatar
| | - Abdelillah Arredouani
- Qatar Biomedical Research Institute, Hamad Ben Khalifa University, HBKU, Doha, Qatar
| | - Hasan Khatib
- Department of Animal Sciences, University of Wisconsin–Madison, Madison, WI, USA
| | - Fouad Azizi
- Interim Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Ramzi M. Mohammad
- Interim Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Muhammad Abdul-Ghani
- Diabetes and Obesity Clinical Research Center, Hamad General Hospital, Doha, Qatar
- Department of Animal Sciences, University of Wisconsin–Madison, Madison, WI, USA
- Interim Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mohamed Chikri
- Biochemistry and Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy of Fez, Sidi Mohammad Ben Abdullah University, Fes, Morocco
- Qatar Biomedical Research Institute, Hamad Ben Khalifa University, HBKU, Doha, Qatar
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Abdul-Ghani T, Puckett C, Migahid O, Abdelgani S, Migahed A, Adams J, Triplitt C, DeFronzo R, Jayyousi A, Abdul-Ghani M. Type 2 diabetes subgroups and response to glucose-lowering therapy: Results from the EDICT and Qatar studies. Diabetes Obes Metab 2022; 24:1810-1818. [PMID: 35581905 DOI: 10.1111/dom.14767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/20/2022] [Accepted: 05/08/2022] [Indexed: 11/29/2022]
Abstract
AIM To examine the efficacy of glucose-lowering medications in subgroups of patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS Cluster analysis was performed in participants in the Efficacy and Durability of Initial Combination Therapy for Type 2 Diabetes (EDICT) study and the Qatar study using age, body mass index (BMI), glycated haemoglobin (HbA1c), and homeostatic model assessment of insulin resistance (HOMA-IR) and beta-cell function (HOMA-β). Participants also underwent an oral glucose tolerance test with measurement of plasma glucose, insulin and C-peptide concentrations to derive independent measures of insulin secretion and insulin sensitivity. The response to glucose-lowering therapies (change in HbA1c) was measured in each participant cluster for 3 years. RESULTS Three distinct and comparable clusters/groups of T2DM patients were identified in both the EDICT and Qatar studies. Participants in Group 1 had the highest HbA1c and manifested severe insulin deficiency. Participants in Group 3 had comparable insulin sensitivity to those in Group 1 but better beta-cell function and better glucose control. Participants in Group 2 had the highest BMI with severe insulin resistance accompanied by marked hyperinsulinaemia, which was primarily attributable to decreased insulin clearance. Unexpectedly, participants in Group 1 had better response to combination therapy with pioglitazone plus exenatide than with insulin therapy or metformin sequentially followed by glipizide and basal insulin, while participants in Group 2 responded equally well to both therapies despite very severe insulin resistance. CONCLUSION Distinct metabolic phenotypes characterize different T2DM clusters and differential responses to glucose-lowering therapies. Participants with severe insulin deficiency respond better to agents that preserve beta-cell function, while, surprisingly, patients with severe insulin resistance did not respond favourably to insulin sensitizers.
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Affiliation(s)
- Tamam Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Curtiss Puckett
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | | | - Siham Abdelgani
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | | | - John Adams
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Curtis Triplitt
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Ralph DeFronzo
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | | | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
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Shannon CE, Merovci A, Fourcaudot M, Tripathy D, Abdul-Ghani M, Wang H, Han X, Norton L, DeFronzo RA. Effects of Sustained Hyperglycemia on Skeletal Muscle Lipids in Healthy Subjects. J Clin Endocrinol Metab 2022; 107:e3177-e3185. [PMID: 35552423 PMCID: PMC9282260 DOI: 10.1210/clinem/dgac306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Sustained increases in plasma glucose promote skeletal muscle insulin resistance independent from obesity and dyslipidemia (ie, glucotoxicity). Skeletal muscle lipids are key molecular determinants of insulin action, yet their involvement in the development of glucotoxicity is unclear. OBJECTIVE To explore the impact of mild physiologic hyperglycemia on skeletal muscle lipids. DESIGN Single group pretest-posttest. PARTICIPANTS Healthy males and females with normal glucose tolerance. INTERVENTIONS 72-hour glucose infusion raising plasma glucose by ~50 mg/dL. MAIN OUTCOME MEASURES Skeletal muscle lipids, insulin sensitivity, lipid oxidation. RESULTS Despite impairing insulin-mediated glucose disposal and suppressing fasting lipid oxidation, hyperglycemia did not alter either the content or composition of skeletal muscle triglycerides, diacylglycerides, or phospholipids. Skeletal muscle ceramides decreased after glucose infusion, likely in response to a reduction in free fatty acid concentrations. CONCLUSIONS Our results demonstrate that the major lipid pools in skeletal muscle are unperturbed by sustained increases in glucose availability and suggest that glucotoxicity and lipotoxicity drive insulin resistance through distinct mechanistic pathways.
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Affiliation(s)
- Christopher E Shannon
- Correspondence: Christopher E Shannon, PhD, UCD Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland. ; Division of Diabetes, Department of Medicine, UT Health San Antonio, San Antonio, TX, USA.
| | - Aurora Merovci
- Division of Diabetes, Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Marcel Fourcaudot
- Division of Diabetes, Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Devjit Tripathy
- Division of Diabetes, Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
- Audie L Murphy VA Hospital, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Muhammad Abdul-Ghani
- Division of Diabetes, Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Hu Wang
- Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, TX, USA
| | - Xianlin Han
- Division of Diabetes, Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
- Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, TX, USA
| | - Luke Norton
- Division of Diabetes, Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Ralph A DeFronzo
- Division of Diabetes, Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
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Spence JD, Viscoli C, Kernan WN, Young LH, Furie K, DeFronzo R, Abdul-Ghani M, Dandona P, Inzucchi SE. Efficacy of lower doses of pioglitazone after stroke or transient ischaemic attack in patients with insulin resistance. Diabetes Obes Metab 2022; 24:1150-1158. [PMID: 35253334 DOI: 10.1111/dom.14687] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/21/2022] [Accepted: 03/01/2022] [Indexed: 12/30/2022]
Abstract
AIMS Pioglitazone is a potent insulin-sensitizing drug with anti-atherosclerotic properties, but adverse effects have limited its use. We assessed the benefits and risks of lower versus higher doses of pioglitazone taken by participants in the Insulin Resistance Intervention in Stroke Trial. MATERIALS AND METHODS Efficacy [myocardial infarction (MI) or recurrent stroke] new-onset diabetes) and adverse outcomes (oedema, weight gain, heart failure and bone fracture) were examined for subjects assigned to pioglitazone or placebo within strata defined by mode dose of study drug taken (i.e. the dose taken on most days in the study). RESULTS Among the 1938 patients randomized to pioglitazone, the mode dose was <15 mg/day in 546 participants, 15 mg/day in 128, 30 mg/day in 89, and 45 mg/day in 1175. There was no significant effect on stroke/MI or new-onset diabetes with <15 mg/day. For 15 mg/30 mg/day pooled, the adjusted hazard ratios (95% CI) for stroke/MI were 0.48 (0.30, 0.76; p = .002) and 0.74 (0.69, 0.94) for 45 mg/day. For new-onset diabetes, the adjusted hazard ratios were 0.34 (0.15, 0.81; p = .001) and 0.31 (0.59, 0.94; p = .001) respectively. For oedema, weight gain and heart failure, the risk estimates for pioglitazone were lower for subjects taking <45 mg daily. For fractures, the increased risk with pioglitazone was similar across all dose strata. CONCLUSIONS Lower doses of pioglitazone appear to confer much of the benefit with less adverse effects than the full dose. Further study is needed to confirm these findings so that clinicians may optimize dosing of this secondary prevention strategy in patients with stroke.
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Affiliation(s)
- J David Spence
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Catherine Viscoli
- Section of General Medicine Yale School of Medicine, New Haven, Connecticut, USA
| | - Walter N Kernan
- Section of General Medicine Yale School of Medicine, New Haven, Connecticut, USA
| | - Lawrence H Young
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Karen Furie
- Department of Neurology, Brown University, Providence, Rhode Island, USA
| | - Ralph DeFronzo
- Diabetes Division, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Muhammad Abdul-Ghani
- Diabetes Division, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Paresh Dandona
- Diabetes Center, Millard Fillmore Hospital, Buffalo, New York, USA
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut, USA
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Lavynenko O, Abdul-Ghani M, Alatrach M, Puckett C, Adams J, Abdelgani S, Alkhouri N, Triplitt C, Clarke GD, Vasquez JA, Li J, Cersosimo E, Gastaldelli A, DeFronzo RA. Combination therapy with pioglitazone/exenatide/metformin reduces the prevalence of hepatic fibrosis and steatosis: The efficacy and durability of initial combination therapy for type 2 diabetes (EDICT). Diabetes Obes Metab 2022; 24:899-907. [PMID: 35014145 DOI: 10.1111/dom.14650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 12/11/2022]
Abstract
AIM To compare the efficacy of triple therapy (metformin/exenatide/pioglitazone) versus stepwise conventional therapy (metformin → glipizide → glargine insulin) on liver fat content and hepatic fibrosis in newly diagnosed, drug-naïve patients with type 2 diabetes. METHODS Sixty-eight patients completed the 6-year follow-up and had an end-of-study (EOS) FibroScan to provide measures of steatosis (controlled attenuation parameter [CAP] in dB/m) and fibrosis (liver stiffness measurement [LSM] in kPa); 59 had magnetic resonance imaging-proton density fat fraction (MRI-PDFF) to measure liver fat. RESULTS At EOS, HbA1c was 6.8% and 6.0% in triple and conventional therapy groups, respectively (P = .0006). Twenty-seven of 39 subjects (69%) receiving conventional therapy had grade 2/3 steatosis (CAP, FibroScan) versus nine of 29 (31%) in triple therapy (P = .0003). Ten of 39 (26%) subjects receiving conventional therapy had stage 3/4 fibrosis (LSM) versus two of 29 (7%) in triple therapy (P = .04). Conventional therapy subjects had more liver fat (MRI-PDFF) than triple therapy (12.9% vs. 8.8%, P = .03). The severity of steatosis (CAP) (r = 0.42, P < .001) and fibrosis (LSM) (r = -0.48, P < .001) correlated inversely with the Matsuda Index of insulin sensitivity, but not with percentage body fat. Aspartate aminotransferase (AST) to Platelet Ratio Index (APRI), non-alcoholic fatty liver disease fibrosis score (NFS), plasma AST, and alanine aminotransferase (ALT) all decreased significantly with triple therapy, but only the decrease in plasma AST and ALT correlated with the severity of steatosis and fibrosis at EOS. CONCLUSIONS At EOS, subjects with type 2 diabetes treated with triple therapy had less hepatic steatosis and fibrosis versus conventional therapy; the severity of hepatic steatosis and fibrosis were both strongly and inversely correlated with insulin resistance; and changes in liver fibrosis scores (APRI, NFS, Fibrosis-4, and AST/ALT ratio) have limited value in predicting response to therapy.
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Affiliation(s)
- Olga Lavynenko
- University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas
| | - Muhammad Abdul-Ghani
- University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas
| | - Mariam Alatrach
- University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas
| | - Curtiss Puckett
- University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas
| | - John Adams
- University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas
| | - Siham Abdelgani
- University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas
| | - Naim Alkhouri
- University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas
| | - Curtis Triplitt
- University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas
| | - Geoffrey D Clarke
- University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas
| | - Juan A Vasquez
- University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas
| | - Jinqi Li
- University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas
| | - Eugenio Cersosimo
- University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas
| | - Amalia Gastaldelli
- University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas
| | - Ralph A DeFronzo
- University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas
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Errafii K, Jayyous A, Arredouani A, Khatib H, Azizi F, Mohammad RM, Abdul-Ghani M, Chikri M. Comprehensive analysis of circulating miRNA expression profiles in insulin resistance and type 2 diabetes in Qatari population. All Life 2022. [DOI: 10.1080/26895293.2022.2033853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Khaoula Errafii
- Biochemistry and Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy of Fez, Sidi Mohammad Ben Abdullah University, Fes, Morocco
- African Genome Center, Mohamed IV Polytechnic, Benguerir, Morocco
- Qatar Biomedical Research Institute, Hamad Ben Khalifa University, HBKU, Doha, Qatar
| | - Amin Jayyous
- Diabetes and Obesity Clinical Research Center, Hamad General Hospital, Doha, Qatar
| | - Abdelillah Arredouani
- Qatar Biomedical Research Institute, Hamad Ben Khalifa University, HBKU, Doha, Qatar
| | - Hasan Khatib
- Department of Animal Sciences, University of Wisconsin–Madison, Madison, WI, USA
| | - Fouad Azizi
- Interim Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Ramzi M. Mohammad
- Interim Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Muhammad Abdul-Ghani
- Diabetes and Obesity Clinical Research Center, Hamad General Hospital, Doha, Qatar
- Department of Animal Sciences, University of Wisconsin–Madison, Madison, WI, USA
- Interim Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mohamed Chikri
- Biochemistry and Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy of Fez, Sidi Mohammad Ben Abdullah University, Fes, Morocco
- Qatar Biomedical Research Institute, Hamad Ben Khalifa University, HBKU, Doha, Qatar
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Al-Shamasi AA, Elkaffash R, Mohamed M, Rayan M, Al-Khater D, Gadeau AP, Ahmed R, Hasan A, Eldassouki H, Yalcin HC, Abdul-Ghani M, Mraiche F. Crosstalk between Sodium-Glucose Cotransporter Inhibitors and Sodium-Hydrogen Exchanger 1 and 3 in Cardiometabolic Diseases. Int J Mol Sci 2021; 22:12677. [PMID: 34884494 PMCID: PMC8657861 DOI: 10.3390/ijms222312677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/14/2022] Open
Abstract
Abnormality in glucose homeostasis due to hyperglycemia or insulin resistance is the hallmark of type 2 diabetes mellitus (T2DM). These metabolic abnormalities in T2DM lead to cellular dysfunction and the development of diabetic cardiomyopathy leading to heart failure. New antihyperglycemic agents including glucagon-like peptide-1 receptor agonists and the sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to attenuate endothelial dysfunction at the cellular level. In addition, they improved cardiovascular safety by exhibiting cardioprotective effects. The mechanism by which these drugs exert their cardioprotective effects is unknown, although recent studies have shown that cardiovascular homeostasis occurs through the interplay of the sodium-hydrogen exchangers (NHE), specifically NHE1 and NHE3, with SGLT2i. Another theoretical explanation for the cardioprotective effects of SGLT2i is through natriuresis by the kidney. This theory highlights the possible involvement of renal NHE transporters in the management of heart failure. This review outlines the possible mechanisms responsible for causing diabetic cardiomyopathy and discusses the interaction between NHE and SGLT2i in cardiovascular diseases.
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Affiliation(s)
- Al-Anood Al-Shamasi
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (A.-A.A.-S.); (R.E.); (M.M.); (M.R.); (D.A.-K.)
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Rozina Elkaffash
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (A.-A.A.-S.); (R.E.); (M.M.); (M.R.); (D.A.-K.)
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Meram Mohamed
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (A.-A.A.-S.); (R.E.); (M.M.); (M.R.); (D.A.-K.)
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Menatallah Rayan
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (A.-A.A.-S.); (R.E.); (M.M.); (M.R.); (D.A.-K.)
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Dhabya Al-Khater
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (A.-A.A.-S.); (R.E.); (M.M.); (M.R.); (D.A.-K.)
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Alain-Pierre Gadeau
- INSERM, Biology of Cardiovascular Disease, University of Bordeaux, U1034 Pessac, France;
| | - Rashid Ahmed
- Department of Mechanical and Chemical Engineering, College of Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (R.A.); (A.H.)
- Biomedical Research Centre (BRC), Qatar University, Doha P.O. Box 2713, Qatar;
| | - Anwarul Hasan
- Department of Mechanical and Chemical Engineering, College of Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (R.A.); (A.H.)
- Biomedical Research Centre (BRC), Qatar University, Doha P.O. Box 2713, Qatar;
| | - Hussein Eldassouki
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B5, Canada;
| | | | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, Floyd Curl Drive, San Antonio, TX 7703, USA;
| | - Fatima Mraiche
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (A.-A.A.-S.); (R.E.); (M.M.); (M.R.); (D.A.-K.)
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
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Abdelgani S, Puckett C, Adams J, Triplitt C, DeFronzo RA, Abdul-Ghani M. Insulin Secretion Predicts the Response to Antidiabetic Therapy in Patients With New-onset Diabetes. J Clin Endocrinol Metab 2021; 106:3497-3504. [PMID: 34343296 PMCID: PMC8787634 DOI: 10.1210/clinem/dgab403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The results of the present study demonstrate that beta cell function in newly diagnosed T2DM patients is the key predictor of response to glucose lowering medications and provides a practical tool (C-Pep120 /C-Pep0) to guide the choice of glucose lowering agent. OBJECTIVE This work aims to identify predictors for individualization of antidiabetic therapy in patients with new-onset type 2 diabetes mellitus (T2DM). METHODS A total of 261 drug-naive participants in the Efficacy and Durability of Initial Combination Therapy for Type 2 Diabetes (EDICT) study, with new-onset diabetes, were randomly assigned in a single-center study to receive 1) metformin followed by glipizide and then insulin glargine on failure to achieve glycated hemoglobin A1c (HbA1c) less than 6.5%, or 2) initial triple therapy with metformin/pioglitazone/exenatide. Each patient received a 75-g oral glucose tolerance test (OGTT) prior to start of therapy. Factors that predicted response to therapy were identified using the area under the receiver operating characteristic curve method. RESULTS Thirty-nine patients started and maintained the treatment goal (HbA1c < 6.5%) on metformin only, and did not require intensification of antihyperglycemic therapy; 54 patients required addition of glipizide to metformin; and 47 patients required insulin addition to metformin plus glipizide for glucose control. The plasma C-peptide concentration (C-Pep)120/C-Pep0 ratio during the OGTT was the strongest predictor of response to therapy. Patients with a ratio less than 1.78 were more likely to require insulin for glucose control, whereas patients with a ratio greater than 2.65 were more likely to achieve glucose control with metformin monotherapy. In patients started on initial triple therapy, the HbA1c decreased independently of the C-Pep120/C-Pep0 ratio. CONCLUSION The increase in C-Pep above fasting following glucose load predicts the response to antihyperglycemic therapy in patients with new-onset diabetes. C-Pep120/C-Pep0 provides a useful tool for the individualization of antihyperglycemic therapy in patients with new-onset T2DM.
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Affiliation(s)
- S Abdelgani
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | - C Puckett
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | - J Adams
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | - C Triplitt
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | - R A DeFronzo
- Correspondence: Ralph A. DeFronzo, MD, Diabetes Division, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| | - M Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
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Abstract
INTRODUCTION Cluster analysis has identified distinct groups of type 2 diabetes (T2D) subjects with distinct metabolic characteristics. Thus, personalizing pharmacologic therapy to individual phenotypic and pathophysiologic characteristics has potential to improve metabolic control and reduce risk of microvascular and macrovascular complications. AREAS COVERED The authors review the classification of T2D, genetic markers, pathophysiology and natural history of T2D, the ABCDE approach to therapy, the ADA/EASD stepwise approach to therapy, available antidiabetic agents, and provide a more rational therapeutic approach based upon pathophysiology and cardiovascular and renal outcome trials. EXPERT OPINION Although insulin resistance is the earliest detectable abnormality, overt T2D does not occur in the absence of progressive beta cell failure. Because of the complex etiology of T2D (Ominous Octet), initiation of therapy with combined agents that (i) target both insulin resistance and beta cell dysfunction and (ii) prevent macrovascular, as well as microvascular, complications will be required. The ratio of C-peptide at 120 minutes (OGTT) to baseline C-peptide predicts with high sensitivity who will respond to metformin, the response to glucose-lowering agents and provides a useful tool to guide optimal glucose lowering therapy.
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DeFronzo RA, Abdul-Ghani M. Sodium-Glucose Cotransporter 2 Inhibitors and the Kidney. Diabetes Spectr 2021; 34:225-234. [PMID: 34511848 PMCID: PMC8387612 DOI: 10.2337/ds20-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Diabetic kidney disease (DKD) accounts for about half of individuals entering end-stage renal disease programs. Patients with DKD frequently have associated microvascular complications and are at very high risk for developing macrovascular complications. Comprehensive treatment involves slowing or preventing the decline in glomerular filtration rate (GFR) and preventing macrovascular and further microvascular complications. Maintaining an A1C <6.5% represents primary prevention; in established DKD, tight blood pressure control is essential. ACE inhibitors/angiotensin receptor blockers (ARBs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors can be used in combination to slow the rate of decline in GFR. This article reviews the general approach to DKD treatment and summarizes renal outcomes in four cardiovascular outcomes trials of SGLT2 inhibitors. Together, these trials provide conclusive evidence that SGLT2 inhibitors, added to an ACE inhibitor or ARB, slow the progression of DKD.
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Abdelgani S, Puckett C, Adams J, Triplitt C, DeFronzo RA, Abdul-Ghani M. Insulin secretion is a strong predictor for need of insulin therapy in patients with new-onset diabetes and HbA1c of more than 10%: A post hoc analysis of the EDICT study. Diabetes Obes Metab 2021; 23:1631-1639. [PMID: 33852204 PMCID: PMC8238899 DOI: 10.1111/dom.14383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023]
Abstract
AIM To identify predictors of response to glucose-lowering therapy in patients with new-onset diabetes and very high HbA1c (>10%). METHODS The study included EDICT participants with an initial HbA1c of more than 10% (N = 104). All subjects received a 75-g oral glucose tolerance test (OGTT) before initiation of therapy, and then were randomized to receive: (a) initial triple therapy with metformin, pioglitazone and exenatide versus (b) stepwise conventional therapy with metformin followed by glipizide and then glargine insulin to reduce HbA1c to less than 6.5%. Insulin secretion and insulin resistance were calculated with OGTT-derived indices. RESULTS Sixty-one per cent of participants in the conventional therapy group achieved HbA1c of less than 6.5% at 6 months without need of insulin therapy compared with 78% in the triple therapy group (P = NS). Insulin secretion at baseline was the strongest predictor of subjects who did not require insulin therapy; a cut point of CPEP120 /CPEP0 -the ratio between plasma C-peptide concentration at 120 minutes during the OGTT and fasting plasma C-peptide concentration-of more than 1.7 predicted subjects who achieved the treatment target without insulin, irrespective of the fasting plasma glucose (FPG) concentration and whether or not they were started on conventional or triple therapy. Subjects with a CPEP120 /CPEP0 of less than 1.7 plus FPG of 269 mg/dL or less (≤14.9 mmoL/L) also achieved the treatment goal with triple therapy. CONCLUSION Insulin secretion in response to a 75-g OGTT predicts the need for insulin therapy at the time of type 2 diabetes (T2D) diagnosis. A cut point of 1.7 of CPEP120 /CPEP0 provides a useful clinical tool to individualize glucose-lowering therapy in patients with new-onset T2D and HbA1c of more than 10%.
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Affiliation(s)
- Siham Abdelgani
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Curtiss Puckett
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | - John Adams
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Curtis Triplitt
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Ralph A DeFronzo
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas, USA
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Ahuja V, Aronen P, Pramodkumar TA, Looker H, Chetrit A, Bloigu AH, Juutilainen A, Bianchi C, La Sala L, Anjana RM, Pradeepa R, Venkatesan U, Jebarani S, Baskar V, Fiorentino TV, Timpel P, DeFronzo RA, Ceriello A, Del Prato S, Abdul-Ghani M, Keinänen-Kiukaanniemi S, Dankner R, Bennett PH, Knowler WC, Schwarz P, Sesti G, Oka R, Mohan V, Groop L, Tuomilehto J, Ripatti S, Bergman M, Tuomi T. Erratum. Accuracy of 1-Hour Plasma Glucose During the Oral Glucose Tolerance Test in Diagnosis of Type 2 Diabetes in Adults: A Meta-analysis. Diabetes Care 2021;44:1062-1069. Diabetes Care 2021; 44:1457. [PMID: 33931489 PMCID: PMC8247490 DOI: 10.2337/dc21-er06c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Ahuja V, Aronen P, Pramodkumar TA, Looker H, Chetrit A, Bloigu AH, Juutilainen A, Bianchi C, La Sala L, Anjana RM, Pradeepa R, Venkatesan U, Jebarani S, Baskar V, Fiorentino TV, Timpel P, DeFronzo RA, Ceriello A, Del Prato S, Abdul-Ghani M, Keinänen-Kiukaanniemi S, Dankner R, Bennett PH, Knowler WC, Schwarz P, Sesti G, Oka R, Mohan V, Groop L, Tuomilehto J, Ripatti S, Bergman M, Tuomi T. Accuracy of 1-Hour Plasma Glucose During the Oral Glucose Tolerance Test in Diagnosis of Type 2 Diabetes in Adults: A Meta-analysis. Diabetes Care 2021; 44:1062-1069. [PMID: 33741697 PMCID: PMC8578930 DOI: 10.2337/dc20-1688] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE One-hour plasma glucose (1-h PG) during the oral glucose tolerance test (OGTT) is an accurate predictor of type 2 diabetes. We performed a meta-analysis to determine the optimum cutoff of 1-h PG for detection of type 2 diabetes using 2-h PG as the gold standard. RESEARCH DESIGN AND METHODS We included 15 studies with 35,551 participants from multiple ethnic groups (53.8% Caucasian) and 2,705 newly detected cases of diabetes based on 2-h PG during OGTT. We excluded cases identified only by elevated fasting plasma glucose and/or HbA1c. We determined the optimal 1-h PG threshold and its accuracy at this cutoff for detection of diabetes (2-h PG ≥11.1 mmol/L) using a mixed linear effects regression model with different weights to sensitivity/specificity (2/3, 1/2, and 1/3). RESULTS Three cutoffs of 1-h PG, at 10.6 mmol/L, 11.6 mmol/L, and 12.5 mmol/L, had sensitivities of 0.95, 0.92, and 0.87 and specificities of 0.86, 0.91, and 0.94 at weights 2/3, 1/2, and 1/3, respectively. The cutoff of 11.6 mmol/L (95% CI 10.6, 12.6) had a sensitivity of 0.92 (0.87, 0.95), specificity of 0.91 (0.88, 0.93), area under the curve 0.939 (95% confidence region for sensitivity at a given specificity: 0.904, 0.946), and a positive predictive value of 45%. CONCLUSIONS The 1-h PG of ≥11.6 mmol/L during OGTT has a good sensitivity and specificity for detecting type 2 diabetes. Prescreening with a diabetes-specific risk calculator to identify high-risk individuals is suggested to decrease the proportion of false-positive cases. Studies including other ethnic groups and assessing complication risk are warranted.
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Affiliation(s)
- Vasudha Ahuja
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Pasi Aronen
- Biostatistics Unit, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - T A Pramodkumar
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
| | - Helen Looker
- Phoenix Epidemiology and Clinical Research Branch, National Institute for Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Angela Chetrit
- Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
| | - Aini H Bloigu
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Auni Juutilainen
- University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Cristina Bianchi
- Section of Diabetes and Metabolic Diseases, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Lucia La Sala
- Department of Cardiovascular and Dysmetabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
| | - Ulagamadesan Venkatesan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
| | - Sarvanan Jebarani
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
| | - Viswanathan Baskar
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Patrick Timpel
- Department of Medicine III, Technical University of Dresden, Dresden, Germany
| | - Ralph A DeFronzo
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Antonio Ceriello
- Department of Cardiovascular and Dysmetabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Stefano Del Prato
- Section of Diabetes and Metabolic Diseases, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Healthcare and Social Services of Selänne, Pyhäjärvi, Finland
| | - Rachel Dankner
- Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel.,Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Peter H Bennett
- Phoenix Epidemiology and Clinical Research Branch, National Institute for Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - William C Knowler
- Phoenix Epidemiology and Clinical Research Branch, National Institute for Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Peter Schwarz
- Department of Medicine III, Technical University of Dresden, Dresden, Germany.,Paul Langerhans Institute of the Helmholtz Zentrum München at the University Hospital Carl Gustav Carus and the Medical Faculty of TU Dresden (PLID), Dresden, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Rie Oka
- Department of Internal Medicine, Hokuriku Central Hospital, Toyama, Japan
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
| | - Leif Groop
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.,Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.,Department of Public Health, Clinicum, University of Helsinki, Helsinki, Finland.,Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA
| | - Michael Bergman
- Division of Endocrinology and Metabolism, Department of Medicine and Department of Population Health, and NYU Langone Diabetes Prevention Program, NYU Grossman School of Medicine, New York, NY
| | - Tiinamaija Tuomi
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.,Lund University Diabetes Centre, Lund University, Malmö, Sweden.,Abdominal Centre, Endocrinology, Helsinki University Hospital, and Folkhalsan Research Centre, Biomedicum, and Research Program Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland
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Affiliation(s)
- Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Correspondence and Reprint Requests: Muhammad Abdul-Ghani, MD, PhD, Diabetes Division, Department of Medicine, UTHSCSA, 7703 Floyd Curl Drive, San Antonio, TX 78229. E-mail:
| | - Ralph A DeFronzo
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Abdul-Ghani M, Puckett C, Adams J, Khattab A, Baskoy G, Cersosimo E, Triplitt C, DeFronzo RA. Durability of Triple Combination Therapy Versus Stepwise Addition Therapy in Patients With New-Onset T2DM: 3-Year Follow-up of EDICT. Diabetes Care 2021; 44:433-439. [PMID: 33273042 PMCID: PMC7818318 DOI: 10.2337/dc20-0978] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/17/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the long-term efficacy of initiating therapy with metformin/pioglitazone/exenatide in patients with new-onset type 2 diabetes mellitus (T2DM) versus sequential addition of metformin followed by glipizide and insulin. RESEARCH DESIGN AND METHODS Drug-naive patients (N = 318) with new-onset T2DM were randomly assigned to receive for 3 years either 1) combination therapy with metformin, pioglitazone, and exenatide (triple therapy) or 2) sequential addition of metformin followed by glipizide and insulin (conventional therapy) to maintain HbA1c at <6.5% (48 mmol/mol). Insulin sensitivity and β-cell function were measured at baseline and 3 years. The primary outcome was the difference in HbA1c between the groups at 3 years. RESULTS Baseline HbA1c ± SEM values were 9.0% ± 0.2% and 8.9% ± 0.2% in the triple therapy and conventional therapy groups, respectively. The decrease in HbA1c resulting from triple therapy was greater at 6 months than that produced by conventional therapy (0.30% [95% CI 0.21-0.39]; P = 0.001), and the HbA1c reduction was maintained at 3 years in patients receiving triple therapy compared with conventional therapy (6.4% ± 0.1% and 6.9% ± 0.1%, respectively), despite intensification of antihyperglycemic therapy in the latter. Thus, the difference in HbA1c between the two treatment groups at 3 years was 0.50% (95% CI 0.39-0.61; P < 0.0001). Triple therapy produced a threefold increase in insulin sensitivity and 30-fold increase in β-cell function. In conventional therapy, insulin sensitivity did not change and β-cell function increased by only 34% (both P < 0.0001 vs. triple therapy). CONCLUSIONS Triple therapy with agents that improve insulin sensitivity and β-cell function in patients with new-onset T2DM produces greater, more durable HbA1c reduction than agents that lower glucose levels without correcting the underlying metabolic defects.
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Affiliation(s)
- Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
| | - Curtiss Puckett
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
| | - John Adams
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
| | - Ahmad Khattab
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
| | - Gozde Baskoy
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
| | - Eugenio Cersosimo
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
| | - Curtis Triplitt
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
| | - Ralph A DeFronzo
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
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Fiorentino TV, Monroy A, Kamath S, Sotero R, Cas MD, Daniele G, Chavez AO, Abdul-Ghani M, Hribal ML, Sesti G, Tripathy D, DeFronzo RA, Folli F. Pioglitazone corrects dysregulation of skeletal muscle mitochondrial proteins involved in ATP synthesis in type 2 diabetes. Metabolism 2021; 114:154416. [PMID: 33137378 DOI: 10.1016/j.metabol.2020.154416] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/25/2022]
Abstract
CONTEXT In this study, we aimed to identify the determinants of mitochondrial dysfunction in skeletal muscle (SKLM) of subjects with type 2 diabetes (T2DM), and to evaluate the effect of pioglitazone (PIO) on SKLM mitochondrial proteome. METHODS Two different groups of adults were studied. Group I consisted of 8 individuals with normal glucose tolerance (NGT) and 8 with T2DM, subjected to SKLM mitochondrial proteome analysis by 2D-gel electrophoresis followed by mass spectrometry-based protein identification. Group II included 24 individuals with NGT and 24 with T2DM, whose SKLM biopsies were subjected to immunoblot analysis. Of the 24 subjects with T2DM, 20 were randomized to receive placebo or PIO (15 mg daily) for 6 months. After 6 months of treatment, SKLM biopsy was repeated. RESULTS Mitochondrial proteomic analysis on Group I revealed that several mitochondrial proteins involved in oxidative metabolism were differentially expressed between T2DM and NGT groups, with a downregulation of ATP synthase alpha chain (ATP5A), electron transfer flavoprotein alpha-subunit (ETFA), cytochrome c oxidase subunit VIb isoform 1 (CX6B1), pyruvate dehydrogenase protein X component (ODPX), dihydrolipoamide dehydrogenase (DLDH), dihydrolipoamide-S-succinyltransferase (DLST), and mitofilin, and an up-regulation of hydroxyacyl-CoA-dehydrogenase (HCDH), 3,2-trans-enoyl-CoA-isomerase (D3D2) and delta3,5-delta2,4-dienoyl-CoA-isomerase (ECH1) in T2DM as compared to NGT subjects. By immunoblot analysis on SKLM lysates obtained from Group II we confirmed that, in comparison to NGT subjects, those with T2DM exhibited lower protein levels of ATP5A (-30%, P = 0.006), ETFA (-50%, P = 0.02), CX6B1 (-30%, P = 0.03), key factors for ATP biosynthesis, and of the structural protein mitofilin (-30%, P = 0.01). T2DM was associated with a reduced abundance of the enzymes involved in the Krebs cycle DLST and ODPX (-20%, P ≤ 0.05) and increased levels of HCDH and ECH1, enzymes implicated in the fatty acid catabolism (+30%, P ≤ 0.05). In subjects with type 2 diabetes treated with PIO for 6 months we found a restored SKLM protein abundance of ATP5A, ETFA, CX6B1, and mitofilin. Moreover, protein levels of HCDH and ECH1 were reduced by -10% and - 15% respectively (P ≤ 0.05 for both) after PIO treatment. CONCLUSION Type 2 diabetes is associated with reduced levels of mitochondrial proteins involved in oxidative phosphorylation and an increased abundance of enzymes implicated in fatty acid catabolism in SKLM. PIO treatment is able to improve SKLM mitochondrial proteomic profile in subjects with T2DM.
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Affiliation(s)
- Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy; Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States of America
| | - Adriana Monroy
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States of America; Oncology, General Hospital of Mexico, Mexico City, Mexico
| | - Subash Kamath
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States of America
| | - Rosa Sotero
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Michele Dei Cas
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Science, University of Milan, Milan, Italy
| | - Giuseppe Daniele
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States of America
| | - Alberto O Chavez
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Muhammad Abdul-Ghani
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States of America
| | - Marta Letizia Hribal
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, Rome, Italy
| | - Devjit Tripathy
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States of America
| | - Ralph A DeFronzo
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States of America
| | - Franco Folli
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States of America; Endocrinology and Metabolism, Department of Health Science, University of Milan, Diabetologia e Malattie Metaboliche, Aziende Socio Sanitarie Territoriali Santi Paolo e Carlo, Milan, Italy.
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Merovci A, Tripathy D, Chen X, Valdez I, Abdul-Ghani M, Solis-Herrera C, Gastaldelli A, DeFronzo RA. Effect of Mild Physiologic Hyperglycemia on Insulin Secretion, Insulin Clearance, and Insulin Sensitivity in Healthy Glucose-Tolerant Subjects. Diabetes 2021; 70:204-213. [PMID: 33033064 PMCID: PMC7881846 DOI: 10.2337/db20-0039] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 10/06/2020] [Indexed: 12/19/2022]
Abstract
The aim of the current study was to evaluate the effect of sustained physiologic increase of ∼50 mg/dL in plasma glucose concentration on insulin secretion in normal glucose-tolerant (NGT) subjects. Twelve NGT subjects without family history of type 2 diabetes mellitus (T2DM; FH-) and 8 NGT with family history of T2DM (FH+) received an oral glucose tolerance test and two-step hyperglycemic clamp (100 and 300 mg/dL) followed by intravenous arginine bolus before and after 72-h glucose infusion. Fasting plasma glucose increased from 94 ± 2 to 142 ± 4 mg/dL for 72 h. First-phase insulin secretion (0-10 min) increased by 70%, while second-phase insulin secretion during the first (10-80 min) and second (90-160 min) hyperglycemic clamp steps increased by 3.8-fold and 1.9-fold, respectively, following 72 h of physiologic hyperglycemia. Insulin sensitivity during hyperglycemic clamp declined by ∼30% and ∼55% (both P < 0.05), respectively, during the first and second hyperglycemic clamp steps. Insulin secretion/insulin resistance (disposition) index declined by 60% (second clamp step) and by 62% following arginine (both P < 0.005) following 72-h glucose infusion. The effect of 72-h glucose infusion on insulin secretion and insulin sensitivity was similar in subjects with and without FH of T2DM. Following 72 h of physiologic hyperglycemia, metabolic clearance rate of insulin was markedly reduced (P < 0.01). These results demonstrate that sustained physiologic hyperglycemia for 72 h 1) increases absolute insulin secretion but impairs β-cell function, 2) causes insulin resistance, and 3) reduces metabolic clearance rate of insulin.
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Affiliation(s)
- Aurora Merovci
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX
| | - Devjit Tripathy
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX
- Audie L. Murphy VA Hospital, South Texas Veterans Heath Care System, Foundation for Advancing Veterans' Health Research, San Antonio, TX
| | - Xi Chen
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX
| | - Ivan Valdez
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX
| | - Muhammad Abdul-Ghani
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX
| | - Carolina Solis-Herrera
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX
| | - Amalia Gastaldelli
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX
| | - Ralph A DeFronzo
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX
- Audie L. Murphy VA Hospital, South Texas Veterans Heath Care System, Foundation for Advancing Veterans' Health Research, San Antonio, TX
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Abdul-Ghani M, Migahid O, Megahed A, DeFronzo RA, Al-Ozairi E, Jayyousi A. Combination therapy with pioglitazone/exenatide improves beta-cell function and produces superior glycaemic control compared with basal/bolus insulin in poorly controlled type 2 diabetes: A 3-year follow-up of the Qatar study. Diabetes Obes Metab 2020; 22:2287-2294. [PMID: 32729222 DOI: 10.1111/dom.14153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 01/09/2023]
Abstract
AIM To examine the long-term efficacy of thiazolidinedione plus a glucagon-like peptide-1 receptor agonist versus basal-bolus insulin on glycaemic control and beta-cell function in patients with poorly controlled type 2 diabetes (T2D) on metformin plus sulphonylurea. MATERIALS AND METHODS Three hundred and thirty-one patients with poorly controlled T2D were recruited over 3 years and were followed for an additional year. Subjects received a 75 g oral glucose tolerance test (OGTT) at baseline and at study end. After completing the baseline OGTT, subjects were randomized to receive either pioglitazone plus weekly exenatide (combination therapy) or basal/bolus insulin (insulin therapy) to maintain an HbA1c of less than 7.0%. The primary outcome of the study was the difference in HbA1c at study end between the two treatment groups. RESULTS Both therapies caused a robust decrease in HbA1c. However, combination therapy caused a greater decrement (-1.1%, P < .0001) than insulin therapy, and more subjects in the combination therapy group (86%) achieved the American Diabetes Association goal of glycaemic control (HbA1c < 7.0%) than those in the insulin therapy group (44%) (P < .0001). Both therapies improved insulin secretion. However, the improvement in insulin secretion with combination therapy was 2.5-fold greater (P < .001) than with insulin therapy (50%). Insulin therapy caused more weight gain and hypoglycaemia. CONCLUSION Both combination therapy and insulin therapy effectively reduced HbA1c in poorly controlled T2D on multiple oral agents. However, combination therapy produced a greater improvement in insulin secretion and decrease in HbA1c with a lower risk of hypoglycaemia.
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Affiliation(s)
- Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Osama Migahid
- Academic Health System, Hamad General Hospital, Doha, Qatar
| | - Ayman Megahed
- Academic Health System, Hamad General Hospital, Doha, Qatar
| | - Ralph A DeFronzo
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | - Amin Jayyousi
- Academic Health System, Hamad General Hospital, Doha, Qatar
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Daniele G, Solis-Herrera C, Dardano A, Mari A, Tura A, Giusti L, Kurumthodathu JJ, Campi B, Saba A, Bianchi AM, Tregnaghi C, Egidi MF, Abdul-Ghani M, DeFronzo R, Del Prato S. Increase in endogenous glucose production with SGLT2 inhibition is attenuated in individuals who underwent kidney transplantation and bilateral native nephrectomy. Diabetologia 2020; 63:2423-2433. [PMID: 32827269 PMCID: PMC7527374 DOI: 10.1007/s00125-020-05254-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/30/2020] [Indexed: 12/02/2022]
Abstract
AIMS/HYPOTHESIS The glucosuria induced by sodium-glucose cotransporter 2 (SGLT2) inhibition stimulates endogenous (hepatic) glucose production (EGP), blunting the decline in HbA1c. We hypothesised that, in response to glucosuria, a renal signal is generated and stimulates EGP. To examine the effect of acute administration of SGLT2 inhibitors on EGP, we studied non-diabetic individuals who had undergone renal transplant with and without removal of native kidneys. METHODS This was a parallel, randomised, double-blind, placebo-controlled, single-centre study, designed to evaluate the effect of a single dose of dapagliflozin or placebo on EGP determined by stable-tracer technique. We recruited non-diabetic individuals who were 30-65 years old, with a BMI of 25-35 kg/m2 and stable body weight (±2 kg) over the preceding 3 months, and HbA1c <42 mmol/mol (6.0%). Participants had undergone renal transplant with and without removal of native kidneys and were on a stable dose of immunosuppressive medications. Participants received a single dose of dapagliflozin 10 mg or placebo on two separate days, at a 5- to 14-day interval, according to randomisation performed by our hospital pharmacy, which provided dapagliflozin and matching placebo, packaged in bulk bottles that were sequentially numbered. Both participants and investigators were blinded to group assignment. RESULTS Twenty non-diabetic renal transplant patients (ten with residual native kidneys, ten with bilateral nephrectomy) participated in the study. Dapagliflozin induced greater glucosuria in individuals with residual native kidneys vs nephrectomised individuals (8.6 ± 1.1 vs 5.5 ± 0.5 g/6 h; p = 0.02; data not shown). During the 6 h study period, plasma glucose decreased only slightly and similarly in both groups, with no difference compared with placebo (data not shown). Following administration of placebo, there was a progressive time-related decline in EGP that was similar in both nephrectomised individuals and individuals with residual native kidneys. Following dapagliflozin administration, EGP declined in both groups, but the differences between the decrement in EGP with dapagliflozin and placebo in the group with bilateral nephrectomy (Δ = 1.11 ± 0.72 μmol min-1 kg-1) was significantly lower (p = 0.03) than in the residual native kidney group (Δ = 2.56 ± 0.33 μmol min-1 kg-1). In the population treated with dapagliflozin, urinary glucose excretion was correlated with EGP (r = 0.34, p < 0.05). Plasma insulin, C-peptide, glucagon, prehepatic insulin:glucagon ratio, lactate, alanine and pyruvate concentrations were similar following placebo and dapagliflozin treatment. β-Hydroxybutyrate increased with dapagliflozin treatment in the residual native kidney group, while a small increase was observed only at 360 min in the nephrectomy group. Plasma adrenaline (epinephrine) did not change after dapagliflozin and placebo treatment in either group. Following dapagliflozin administration, plasma noradrenaline (norepinephrine) increased slightly in the residual native kidney group and decreased in the nephrectomy group. CONCLUSIONS/INTERPRETATION In nephrectomised individuals, the hepatic compensatory response to acute SGLT2 inhibitor-induced glucosuria was attenuated, as compared with individuals with residual native kidneys, suggesting that SGLT2 inhibitor-mediated stimulation of hepatic glucose production via efferent renal nerves occurs in an attempt to compensate for the urinary glucose loss (i.e. a renal-hepatic axis). TRIAL REGISTRATION ClinicalTrials.gov NCT03168295 FUNDING: This protocol was supported by Qatar National Research Fund (QNRF) Award No. NPRP 8-311-3-062 and NIH grant DK024092-38. Graphical abstract.
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Affiliation(s)
- Giuseppe Daniele
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Carolina Solis-Herrera
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Angela Dardano
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Andrea Mari
- Metabolic Unit, CNR Institute of Neuroscience, Padova, Italy
| | - Andrea Tura
- Metabolic Unit, CNR Institute of Neuroscience, Padova, Italy
| | - Laura Giusti
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Jancy J Kurumthodathu
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Beatrice Campi
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Alessandro Saba
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Anna Maria Bianchi
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Carla Tregnaghi
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Maria Francesca Egidi
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ralph DeFronzo
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Ali AM, Mari A, Martinez R, Al-Jobori H, Adams J, Triplitt C, DeFronzo R, Cersosimo E, Abdul-Ghani M. Improved Beta Cell Glucose Sensitivity Plays Predominant Role in the Decrease in HbA1c with Cana and Lira in T2DM. J Clin Endocrinol Metab 2020; 105:5880025. [PMID: 32745202 DOI: 10.1210/clinem/dgaa494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 07/31/2020] [Indexed: 12/12/2022]
Abstract
AIM To examine the effect of combination therapy with canagliflozin plus liraglutide versus each agent alone on beta cell function in type 2 diabetes mellitus (T2DM) patients. RESEARCH DESIGN AND METHODS A total of 45 poorly controlled (HbA1c = 7%-11%) T2DM patients received an oral glucose tolerance test (OGTT) before and after 16 weeks of treatment with: (i) liraglutide (LIRA); (ii) canagliflozin (CANA); (iii) liraglutide plus canagliflozin (CANA/LIRA). RESULTS Both liraglutide and canagliflozin significantly lowered HbA1c with no significant additive effect of the combination on HbA1c (0.89%, 1.43%, and 1.67% respectively). Insulin secretion during the OGTT, measured with (∆C-Pep/∆G)0-120, increased in the 3 groups (from 0.30 ± 0.06 to 0.48 ± 0.10; 0.29 ± 0.05 to 0.98 ± 0.23; and 0.24 ± 0.06 to 1.09 ± 0.12 in subjects receiving CANA, LIRA and CANA/LIRA respectively; P = 0.02 for CANA vs LIRA, P < 0.0001, CANA/LIRA vs CANA), and the increase in insulin secretion was associated with an increase in beta cell glucose sensitivity (29 ± 5 to 55 ± 11; 33 ± 6 to 101 ± 16; and 28 ± 6 to 112 ± 12, respectively; P = 0.01 for CANA vs LIRA, P < 0.0001, CANA/LIRA vs CANA). No significant difference in the increase in insulin secretion or beta cell glucose sensitivity was observed between subjects in LIRA or CANA/LIRA groups. The decrease in HbA1c strongly and inversely correlated with the increase in beta cell glucose sensitivity (r = 0.71, P < 0.001). In multivariate regression model, improved beta cell glucose sensitivity was the strongest predictor of HbA1c decrease with each therapy. CONCLUSION Improved beta cell glucose sensitivity with canagliflozin monotherapy and liraglutide monotherapy or in combination is major factor responsible for the HbA1c decrease. Canagliflozin failed to produce an additive effect to improve beta cell glucose sensitivity above that observed with liraglutide.
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Affiliation(s)
- Ali Muhammed Ali
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas
| | - Andrea Mari
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas
| | - Robert Martinez
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas
| | - Hussein Al-Jobori
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas
| | - John Adams
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas
| | - Curtis Triplitt
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas
| | - Ralph DeFronzo
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas
| | - Eugenio Cersosimo
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas
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Laichuthai N, Abdul-Ghani M, Kosiborod M, Parksook WW, Kerr SJ, DeFronzo RA. Newly Discovered Abnormal Glucose Tolerance in Patients With Acute Myocardial Infarction and Cardiovascular Outcomes: A Meta-analysis. Diabetes Care 2020; 43:1958-1966. [PMID: 32669411 DOI: 10.2337/dc20-0059] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/31/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The prevalence of unrecognized abnormal glucose tolerance (AGT) and the incidence of recurrent cardiovascular (CV) events in patients with acute myocardial infarction (MI) has not been systematically evaluated. PURPOSE The purposes of this study were to define the prevalence of newly discovered AGT and examine the risk of recurrent major adverse cardiac events (MACE) and mortality in patients with acute MI. DATA SOURCES Medline, Embase, Cochrane Library, and Google Scholar were searched for relevant articles. STUDY SELECTION Inclusion criteria included prospective studies in patients with acute MI without known history of diabetes; AGT diagnosed using fasting plasma glucose, 2-h oral glucose tolerance test, or HbA1c; and incidence of MACE and/or all-cause mortality in newly discovered AGT. DATA EXTRACTION Two investigators extracted the data. Pooled prevalence, incidence rate ratios, and hazard ratios (HRs) were calculated using random-effects models. DATA SYNTHESIS In 19 studies (n = 41,509, median follow-up 3.1 years), prevalence of newly discovered AGT was 48.4% (95% CI 40.2-56.6). Prediabetes had a higher mortality risk than normal glucose tolerance (NGT) (HR 1.36 [95% CI 1.13-1.63], P < 0.001) and MACE (1.42 [1.20-1.68], P < 0.001). Newly diagnosed diabetes had higher mortality risk than NGT (1.74 [1.48-2.05], P < 0.001) and MACE (1.54 [1.23-1.93], P < 0.001). LIMITATIONS This is not a meta-analysis of individual patient data. Time-to-event analysis and covariate-adjusted analysis cannot be conducted to examine heterogeneity reliably. Few studies reported CV death and heart failure hospitalizations. CONCLUSIONS Patients with acute MI have a high prevalence of newly discovered AGT. Aggressive risk reduction strategies in this population, especially in those with prediabetes, are warranted.
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Affiliation(s)
- Nitchakarn Laichuthai
- Diabetes Division, UT Health San Antonio, and Texas Diabetes Institute, San Antonio, TX.,Excellence Center in Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Muhammad Abdul-Ghani
- Diabetes Division, UT Health San Antonio, and Texas Diabetes Institute, San Antonio, TX
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute, Saint Luke's Hospital of Kansas City, Kansas City, MO.,The George Institute for Global Health and University of New South Wales, Sydney, New South Wales, Australia
| | - Wasita Warachit Parksook
- Excellence Center in Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of General Internal Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Stephen J Kerr
- Biostatistics Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Ralph A DeFronzo
- Diabetes Division, UT Health San Antonio, and Texas Diabetes Institute, San Antonio, TX
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Bergman M, Abdul-Ghani M, Neves JS, Monteiro MP, Medina JL, Dorcely B, Buysschaert M. Pitfalls of HbA1c in the Diagnosis of Diabetes. J Clin Endocrinol Metab 2020; 105:dgaa372. [PMID: 32525987 PMCID: PMC7335015 DOI: 10.1210/clinem/dgaa372] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023]
Abstract
Many health care providers screen high-risk individuals exclusively with an HbA1c despite its insensitivity for detecting dysglycemia. The 2 cases presented describe the inherent caveats of interpreting HbA1c without performing an oral glucose tolerance test (OGTT). The first case reflects the risk of overdiagnosing type 2 diabetes (T2D) in an older African American male in whom HbA1c levels, although variable, were primarily in the mid-prediabetes range (5.7-6.4% [39-46 mmol/mol]) for many years although the initial OGTT demonstrated borderline impaired fasting glucose with a fasting plasma glucose of 102 mg/dL [5.7 mmol/L]) without evidence for impaired glucose tolerance (2-hour glucose ≥140-199 mg/dl ([7.8-11.1 mmol/L]). Because subsequent HbA1c levels were diagnostic of T2D (6.5%-6.6% [48-49 mmol/mol]), a second OGTT performed was normal. The second case illustrates the risk of underdiagnosing T2D in a male with HIV having normal HbA1c levels over many years who underwent an OGTT when mild prediabetes (HbA1c = 5.7% [39 mmol/mol]) developed that was diagnostic of T2D. To avoid inadvertent mistreatment, it is therefore essential to perform an OGTT, despite its limitations, in high-risk individuals, particularly when glucose or fructosamine and HbA1c values are discordant. Innate differences in the relationship between fructosamine or fasting glucose to HbA1c are demonstrated by the glycation gap or hemoglobin glycation index.
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Affiliation(s)
- Michael Bergman
- NYU School of Medicine, Director, NYU Diabetes Prevention Program, Section Chief, Endocrinology, Diabetes, Metabolism, VA New York Harbor Healthcare System, Manhattan Campus, New York, New York
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - João Sérgio Neves
- Department of Surgery and Physiology, Cardiovascular Research Center, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and Metabolism, São João University Hospital Center, Porto, Portugal
| | - Mariana P Monteiro
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | | | - Brenda Dorcely
- NYU Grossman School of Medicine, Division of Endocrinology, Diabetes, Metabolism, New York, New York
| | - Martin Buysschaert
- Department of Endocrinology and Diabetology, Université Catholique de Louvain, University Clinic Saint-Luc, Brussels, Belgium
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Bergman M, Abdul-Ghani M, DeFronzo RA, Manco M, Sesti G, Fiorentino TV, Ceriello A, Rhee M, Phillips LS, Chung S, Cravalho C, Jagannathan R, Monnier L, Colette C, Owens D, Bianchi C, Del Prato S, Monteiro MP, Neves JS, Medina JL, Macedo MP, Ribeiro RT, Filipe Raposo J, Dorcely B, Ibrahim N, Buysschaert M. Review of methods for detecting glycemic disorders. Diabetes Res Clin Pract 2020; 165:108233. [PMID: 32497744 PMCID: PMC7977482 DOI: 10.1016/j.diabres.2020.108233] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023]
Abstract
Prediabetes (intermediate hyperglycemia) consists of two abnormalities, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) detected by a standardized 75-gram oral glucose tolerance test (OGTT). Individuals with isolated IGT or combined IFG and IGT have increased risk for developing type 2 diabetes (T2D) and cardiovascular disease (CVD). Diagnosing prediabetes early and accurately is critical in order to refer high-risk individuals for intensive lifestyle modification. However, there is currently no international consensus for diagnosing prediabetes with HbA1c or glucose measurements based upon American Diabetes Association (ADA) and the World Health Organization (WHO) criteria that identify different populations at risk for progressing to diabetes. Various caveats affecting the accuracy of interpreting the HbA1c including genetics complicate this further. This review describes established methods for detecting glucose disorders based upon glucose and HbA1c parameters as well as novel approaches including the 1-hour plasma glucose (1-h PG), glucose challenge test (GCT), shape of the glucose curve, genetics, continuous glucose monitoring (CGM), measures of insulin secretion and sensitivity, metabolomics, and ancillary tools such as fructosamine, glycated albumin (GA), 1,5- anhydroglucitol (1,5-AG). Of the approaches considered, the 1-h PG has considerable potential as a biomarker for detecting glucose disorders if confirmed by additional data including health economic analysis. Whether the 1-h OGTT is superior to genetics and omics in providing greater precision for individualized treatment requires further investigation. These methods will need to demonstrate substantially superiority to simpler tools for detecting glucose disorders to justify their cost and complexity.
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Affiliation(s)
- Michael Bergman
- NYU School of Medicine, NYU Diabetes Prevention Program, Endocrinology, Diabetes, Metabolism, VA New York Harbor Healthcare System, Manhattan Campus, 423 East 23rd Street, Room 16049C, NY, NY 10010, USA.
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
| | - Ralph A DeFronzo
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
| | - Melania Manco
- Research Area for Multifactorial Diseases, Bambino Gesù Children Hospital, Rome, Italy.
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome 00161, Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro 88100, Italy.
| | - Antonio Ceriello
- Department of Cardiovascular and Metabolic Diseases, Istituto Ricerca Cura Carattere Scientifico Multimedica, Sesto, San Giovanni (MI), Italy.
| | - Mary Rhee
- Emory University School of Medicine, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta VA Health Care System, Atlanta, GA 30322, USA.
| | - Lawrence S Phillips
- Emory University School of Medicine, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta VA Health Care System, Atlanta, GA 30322, USA.
| | - Stephanie Chung
- Diabetes Endocrinology and Obesity Branch, National Institutes of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Celeste Cravalho
- Diabetes Endocrinology and Obesity Branch, National Institutes of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Ram Jagannathan
- Emory University School of Medicine, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta VA Health Care System, Atlanta, GA 30322, USA.
| | - Louis Monnier
- Institute of Clinical Research, University of Montpellier, Montpellier, France.
| | - Claude Colette
- Institute of Clinical Research, University of Montpellier, Montpellier, France.
| | - David Owens
- Diabetes Research Group, Institute of Life Science, Swansea University, Wales, UK.
| | - Cristina Bianchi
- University Hospital of Pisa, Section of Metabolic Diseases and Diabetes, University Hospital, University of Pisa, Pisa, Italy.
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Mariana P Monteiro
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal; Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.
| | - João Sérgio Neves
- Department of Surgery and Physiology, Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Endocrinology, Diabetes and Metabolism, São João University Hospital Center, Porto, Portugal.
| | | | - Maria Paula Macedo
- CEDOC-Centro de Estudos de Doenças Crónicas, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal; APDP-Diabetes Portugal, Education and Research Center (APDP-ERC), Lisboa, Portugal.
| | - Rogério Tavares Ribeiro
- Institute for Biomedicine, Department of Medical Sciences, University of Aveiro, APDP Diabetes Portugal, Education and Research Center (APDP-ERC), Aveiro, Portugal.
| | - João Filipe Raposo
- CEDOC-Centro de Estudos de Doenças Crónicas, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal; APDP-Diabetes Portugal, Education and Research Center (APDP-ERC), Lisboa, Portugal.
| | - Brenda Dorcely
- NYU School of Medicine, Division of Endocrinology, Diabetes, Metabolism, NY, NY 10016, USA.
| | - Nouran Ibrahim
- NYU School of Medicine, Division of Endocrinology, Diabetes, Metabolism, NY, NY 10016, USA.
| | - Martin Buysschaert
- Department of Endocrinology and Diabetology, Université Catholique de Louvain, University Clinic Saint-Luc, Brussels, Belgium.
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Ali AM, Martinez R, Al-Jobori H, Adams J, Triplitt C, DeFronzo R, Cersosimo E, Abdul-Ghani M. Combination Therapy With Canagliflozin Plus Liraglutide Exerts Additive Effect on Weight Loss, but Not on HbA 1c, in Patients With Type 2 Diabetes. Diabetes Care 2020; 43:1234-1241. [PMID: 32220916 PMCID: PMC7411279 DOI: 10.2337/dc18-2460] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/27/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the effect of combination therapy with canagliflozin plus liraglutide on HbA1c, endogenous glucose production (EGP), and body weight versus each therapy alone. RESEARCH DESIGN AND METHODS Forty-five patients with poorly controlled (HbA1c 7-11%) type 2 diabetes mellitus (T2DM) on metformin with or without sulfonylurea received a 9-h measurement of EGP with [3-3H]glucose infusion, after which they were randomized to receive 1) liraglutide 1.2 mg/day (LIRA), 2) canagliflozin 100 mg/day (CANA), or 3) liraglutide 1.2 mg plus canagliflozin 100 mg (CANA/LIRA) for 16 weeks. At 16 weeks, the EGP measurement was repeated. RESULTS The mean decrease from baseline to 16 weeks in HbA1c was -1.67 ± 0.29% (P = 0.0001), -0.89 ± 0.24% (P = 0.002), and -1.44 ± 0.39% (P = 0.004) in patients receiving CANA/LIRA, CANA, and LIRA, respectively. The decrease in body weight was -6.0 ± 0.8 kg (P < 0.0001), -3.5 ± 0.5 kg (P < 0.0001), and -1.9 ± 0.8 kg (P = 0.03), respectively. CANA monotherapy caused a 9% increase in basal rate of EGP (P < 0.05), which was accompanied by a 50% increase (P < 0.05) in plasma glucagon-to-insulin ratio. LIRA monotherapy reduced plasma glucagon concentration and inhibited EGP. In CANA/LIRA-treated patients, EGP increased by 15% (P < 0.05), even though the plasma insulin response was maintained at baseline and the CANA-induced rise in plasma glucagon concentration was blocked. CONCLUSIONS These results demonstrate that liraglutide failed to block the increase in EGP caused by canagliflozin despite blocking the rise in plasma glucagon and preventing the decrease in plasma insulin concentration caused by canagliflozin. The failure of liraglutide to prevent the increase in EGP caused by canagliflozin explains the lack of additive effect of these two agents on HbA1c.
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Affiliation(s)
- Ali Muhammed Ali
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Robert Martinez
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Hussein Al-Jobori
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - John Adams
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Curtis Triplitt
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ralph DeFronzo
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Eugenio Cersosimo
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
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Solis-Herrera C, Daniele G, Alatrach M, Agyin C, Triplitt C, Adams J, Patel R, Gastaldelli A, Honka H, Chen X, Abdul-Ghani M, Cersosimo E, Del Prato S, DeFronzo R. Increase in Endogenous Glucose Production With SGLT2 Inhibition Is Unchanged by Renal Denervation and Correlates Strongly With the Increase in Urinary Glucose Excretion. Diabetes Care 2020; 43:1065-1069. [PMID: 32144165 PMCID: PMC7171949 DOI: 10.2337/dc19-2177] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/25/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Sodium-glucose cotransporter 2 (SGLT2) inhibition causes an increase in endogenous glucose production (EGP). However, the mechanisms are unclear. We studied the effect of SGLT2 inhibitors on EGP in subjects with type 2 diabetes (T2D) and without diabetes (non-DM) in kidney transplant recipients with renal denervation. RESEARCH DESIGN AND METHODS Fourteen subjects who received a renal transplant (six with T2D [A1C 7.2 ± 0.1%] and eight non-DM [A1C 5.6 ± 0.1%) underwent measurement of EGP with [3-3H]glucose infusion following dapagliflozin (DAPA) 10 mg or placebo. Plasma glucose, insulin, C-peptide, glucagon, and titrated glucose-specific activity were measured. RESULTS Following placebo in T2D, fasting plasma glucose (FPG) (143 ± 14 to 124 ± 10 mg/dL; P = 0.02) and fasting plasma insulin (12 ± 2 to 10 ± 1.1 μU/mL; P < 0.05) decreased; plasma glucagon was unchanged, and EGP declined. After DAPA in T2D, FPG (143 ± 15 to 112 ± 9 mg/dL; P = 0.01) and fasting plasma insulin (14 ± 3 to 11 ± 2 μU/mL; P = 0.02) decreased, and plasma glucagon increased (all P < 0.05 vs. placebo). EGP was unchanged from baseline (2.21 ± 0.19 vs. 1.96 ± 0.14 mg/kg/min) in T2D (P < 0.001 vs. placebo). In non-DM following DAPA, FPG and fasting plasma insulin decreased, and plasma glucagon was unchanged. EGP was unchanged from baseline (1.85 ± 0.10 to 1.78 ± 0.10 mg/kg/min) after DAPA, whereas EGP declined significantly with placebo. When the increase in EGP production following DAPA versus placebo was plotted against the difference in urinary glucose excretion (UGE) for all patients, a strong correlation (r = 0.824; P < 0.001) was observed. CONCLUSIONS Renal denervation in patients who received a kidney transplant failed to block the DAPA-mediated stimulation of EGP in both individuals with T2D and non-DM subjects. The DAPA-stimulated rise in EGP is strongly related to the increase in UGE, blunting the decline in FPG.
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Affiliation(s)
- Carolina Solis-Herrera
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Giuseppe Daniele
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX.,Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mariam Alatrach
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Christina Agyin
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Curtis Triplitt
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - John Adams
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Rupal Patel
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Amalia Gastaldelli
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX.,Institute of Clinical Physiology, Pisa, Italy
| | - Henri Honka
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Xi Chen
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Muhammad Abdul-Ghani
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Eugenio Cersosimo
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Stephano Del Prato
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Ralph DeFronzo
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
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Alatrach M, Laichuthai N, Martinez R, Agyin C, Ali AM, Al-Jobori H, Lavynenko O, Adams J, Triplitt C, DeFronzo R, Cersosimo E, Abdul-Ghani M. Evidence Against an Important Role of Plasma Insulin and Glucagon Concentrations in the Increase in EGP Caused by SGLT2 Inhibitors. Diabetes 2020; 69:681-688. [PMID: 31915153 PMCID: PMC7085246 DOI: 10.2337/db19-0770] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/01/2020] [Indexed: 12/20/2022]
Abstract
Sodium-glucose cotransport 2 inhibitors (SGLT2i) lower plasma glucose but stimulate endogenous glucose production (EGP). The current study examined the effect of dapagliflozin on EGP while clamping plasma glucose, insulin, and glucagon concentrations at their fasting level. Thirty-eight patients with type 2 diabetes received an 8-h measurement of EGP ([3-3H]-glucose) on three occasions. After a 3-h tracer equilibration, subjects received 1) dapagliflozin 10 mg (n = 26) or placebo (n = 12); 2) repeat EGP measurement with the plasma glucose concentration clamped at the fasting level; and 3) repeat EGP measurement with inhibition of insulin and glucagon secretion with somatostatin infusion and replacement of basal plasma insulin and glucagon concentrations. In study 1, the change in EGP (baseline to last hour of EGP measurement) in subjects receiving dapagliflozin was 22% greater (+0.66 ± 0.11 mg/kg/min, P < 0.05) than in subjects receiving placebo, and it was associated with a significant increase in plasma glucagon and a decrease in the plasma insulin concentration compared with placebo. Under glucose clamp conditions (study 2), the change in plasma insulin and glucagon concentrations was comparable in subjects receiving dapagliflozin and placebo, yet the difference in EGP between dapagliflozin and placebo persisted (+0.71 ± 0.13 mg/kg/min, P < 0.01). Under pancreatic clamp conditions (study 3), dapagliflozin produced an initial large decrease in EGP (8% below placebo), followed by a progressive increase in EGP that was 10.6% greater than placebo during the last hour. Collectively, these results indicate that 1) the changes in plasma insulin and glucagon concentration after SGLT2i administration are secondary to the decrease in plasma glucose concentration, and 2) the dapagliflozin-induced increase in EGP cannot be explained by the increase in plasma glucagon or decrease in plasma insulin or glucose concentrations.
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Affiliation(s)
- Mariam Alatrach
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Nitchakarn Laichuthai
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Robert Martinez
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Christina Agyin
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ali Muhammed Ali
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Hussein Al-Jobori
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Olga Lavynenko
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - John Adams
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Curtis Triplitt
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ralph DeFronzo
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Eugenio Cersosimo
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
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Cagiltay E, Celik A, Dixon JB, Pouwels S, Santoro S, Gupta A, Ugale S, Abdul-Ghani M. Effects of different metabolic states and surgical models on glucose metabolism and secretion of ileal L-cell peptides: results from the HIPER-1 study. Diabet Med 2020; 37:697-704. [PMID: 31773794 DOI: 10.1111/dme.14191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 12/13/2022]
Abstract
AIM To compare the impact of four surgical procedures (mini-gastric bypass, sleeve gastrectomy, ileal transposition and transit bipartition) vs medical management on gut peptide secretion, β-cell function and resolution of hyperglycaemia in people with type 2 diabetes. RESEARCH DESIGN AND METHODS A mixed-meal tolerance test was administered 6-24 months after each surgical procedure (mini-gastric bypass, sleeve gastrectomy, ileal transposition and transit bipartition; n=30 in each group) and the results were compared with those obtained in matched lean (n=30) and obese (n=30) people with type 2 diabetes undergoing medical management. RESULTS Participants in the mini-gastric bypass and ileal transposition groups had a greater increase in plasma glucose concentration after the mixed-meal tolerance test than those in the sleeve gastrectomy and transit bipartition groups. Participants in the mini-gastric bypass group exhibited the greatest increase in the incremental area under the curve of plasma glucose concentration above baseline (P<0.0001). Insulin sensitivity was similar across surgical groups, and statistically greater in participants in the surgical groups than in obese participants in the non-surgical group (P<0.0001). β-cell responsiveness to glucose was greater in participants in the sleeve gastrectomy and transit bipartition groups than in the mini-gastric bypass and ileal transposition groups (P<0.001) despite a smaller incremental increase above baseline in the area under the plasma glucagon-like peptide-1 concentration curve relative to ileal transposition. Postoperative β-cell function was the strongest predictor of hyperglycaemia resolution. CONCLUSIONS The present study showed that the level of β-cell function after bariatric surgery is the strongest predictor of hyperglycaemia resolution. The study also demonstrates a disconnect between postprandial GLP-1 levels and β-cell function among the studied surgical procedures.
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Affiliation(s)
- E Cagiltay
- Department of Immunology, Faculty of Medicine, Saglik Bilimleri University, Istanbul, Turkey
| | - A Celik
- Metabolic Surgery Clinic, Istanbul, Sisli, Turkey
| | - J B Dixon
- Laboratory of Human Neurotransmitters, Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia
- Department of Primary Health Care, Monash University, Melbourne, Vic., Australia
| | - S Pouwels
- Department of Surgery, Haaglanden Medical Centre, The Hague, Netherlands
| | - S Santoro
- Department of Surgery, Albert Einstein Hospital, Sao Paolo, Brazil
| | - A Gupta
- Centre for Medical Weight Loss and Metabolic Control, Rowan University, Stratford, NJ, USA
| | - S Ugale
- Department of Bariatric and Metabolic Surgery, Kirloskar Hospital, Hyderabad, India
| | - M Abdul-Ghani
- Cardio-Metabolic Institute, AHS, HMC, Doha, Qatar
- Diabetes Division, University of Texas Health Science Centre, San Antonio, TX, USA
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Srikantan S, Deng Y, Cheng ZM, Luo A, Qin Y, Gao Q, Sande-Docor GM, Tao S, Zhang X, Harper N, Shannon CE, Fourcaudot M, Li Z, Kasinath BS, Harrison S, Ahuja S, Reddick RL, Dong LQ, Abdul-Ghani M, Norton L, Aguiar RCT, Dahia PLM. The tumor suppressor TMEM127 regulates insulin sensitivity in a tissue-specific manner. Nat Commun 2019; 10:4720. [PMID: 31624249 PMCID: PMC6797792 DOI: 10.1038/s41467-019-12661-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 09/20/2019] [Indexed: 02/03/2023] Open
Abstract
Understanding the molecular components of insulin signaling is relevant to effectively manage insulin resistance. We investigated the phenotype of the TMEM127 tumor suppressor gene deficiency in vivo. Whole-body Tmem127 knockout mice have decreased adiposity and maintain insulin sensitivity, low hepatic fat deposition and peripheral glucose clearance after a high-fat diet. Liver-specific and adipose-specific Tmem127 deletion partially overlap global Tmem127 loss: liver Tmem127 promotes hepatic gluconeogenesis and inhibits peripheral glucose uptake, while adipose Tmem127 downregulates adipogenesis and hepatic glucose production. mTORC2 is activated in TMEM127-deficient hepatocytes suggesting that it interacts with TMEM127 to control insulin sensitivity. Murine hepatic Tmem127 expression is increased in insulin-resistant states and is reversed by diet or the insulin sensitizer pioglitazone. Importantly, human liver TMEM127 expression correlates with steatohepatitis and insulin resistance. Our results suggest that besides tumor suppression activities, TMEM127 is a nutrient-sensing component of glucose/lipid homeostasis and may be a target in insulin resistance.
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Affiliation(s)
- Subramanya Srikantan
- Division of Hematology and Medical Oncology, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Yilun Deng
- Division of Hematology and Medical Oncology, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Zi-Ming Cheng
- Division of Hematology and Medical Oncology, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Anqi Luo
- Division of Hematology and Medical Oncology, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Yuejuan Qin
- Division of Hematology and Medical Oncology, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Qing Gao
- Division of Hematology and Medical Oncology, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Glaiza-Mae Sande-Docor
- Division of Hematology and Medical Oncology, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Sifan Tao
- Division of Hematology and Medical Oncology, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Xingyu Zhang
- Division of Hematology and Medical Oncology, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Nathan Harper
- Division of Infectious Diseases, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Chris E Shannon
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Marcel Fourcaudot
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Zhi Li
- Department of Cellular Systems and Anatomy, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
- Department of Nephrology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Balakuntalam S Kasinath
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Stephen Harrison
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Sunil Ahuja
- Division of Infectious Diseases, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
- South Texas Veterans Health Care System, Audie Murphy VA Hospital, San Antonio, TX, USA
| | - Robert L Reddick
- Department of Pathology, UTHSCSA, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Lily Q Dong
- Department of Cellular Systems and Anatomy, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Muhammad Abdul-Ghani
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Luke Norton
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
| | - Ricardo C T Aguiar
- Division of Hematology and Medical Oncology, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA
- South Texas Veterans Health Care System, Audie Murphy VA Hospital, San Antonio, TX, USA
- Mays Cancer Center, UTHSCSA, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Patricia L M Dahia
- Division of Hematology and Medical Oncology, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, TX, 78229, USA.
- Mays Cancer Center, UTHSCSA, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
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Binda P, Eldor R, Huerta C, Adams J, Lancaster J, Fox P, Del Prato S, DeFronzo R, Abdul-Ghani M, Daniele G. Exenatide modulates visual cortex responses. Diabetes Metab Res Rev 2019; 35:e3167. [PMID: 30974038 PMCID: PMC6718343 DOI: 10.1002/dmrr.3167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 03/25/2019] [Accepted: 04/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Increasing evidence suggests that metabolism affects brain physiology. Here, we examine the effect of GLP-1 on simple visual-evoked functional Magnetic Resonance Imaging (fMRI) responses in cortical areas. METHODS Lean (n = 10) and nondiabetic obese (n = 10) subjects received exenatide (a GLP-1 agonist) or saline infusion, and fMRI responses to visual stimuli (food and nonfood images) were recorded. We analysed the effect of exenatide on fMRI signals across the cortical surface with special reference to the visual areas. We evaluated the effects of exenatide on the raw fMRI signal and on the fMRI signal change during visual stimulation (vs rest). RESULTS In line with previous studies, we find that exenatide eliminates the preference for food (over nonfood) images present under saline infusion in high-level visual cortex (temporal pole). In addition, we find that exenatide (vs saline) also modulates the response of early visual areas, enhancing responses to both food and nonfood images in several extrastriate occipital areas, similarly in obese and lean participants. Unexpectedly, exenatide increased fMRI raw signals (signal intensity during rest periods without stimulation) in a large occipital region, which were negatively correlated to BMI. CONCLUSIONS In both lean and obese individuals, exenatide affects neural processing in visual cortex, both in early visual areas and in higher order areas. This effect may contribute to the known effect of GLP1 analogues on food-related behaviour.
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Affiliation(s)
- Paola Binda
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa. Pisa. Italy
| | - Roy Eldor
- Diabetes Unit-Institute of Endocrinology, Metabolism & Hypertension at The Tel Aviv Sourasky Medical Center. Tel-Aviv. Israel
| | - Claudia Huerta
- Imaging Research Center University of Texas Health Science Center at San Antonio. San Antonio, TX. US
| | - John Adams
- Imaging Research Center University of Texas Health Science Center at San Antonio. San Antonio, TX. US
| | - John Lancaster
- Division of Diabetes, University of Texas Health Science Center at San Antonio. San Antonio, TX. US
| | - Peter Fox
- Division of Diabetes, University of Texas Health Science Center at San Antonio. San Antonio, TX. US
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine. Section of Diabetes. University of Pisa. Pisa. Italy
| | - Ralph DeFronzo
- Division of Diabetes, University of Texas Health Science Center at San Antonio. San Antonio, TX. US
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio. San Antonio, TX. US
- Diabetes and Obesity Clinical Research Center, Hamad General Hospital, Doha, Qatar
| | - Giuseppe Daniele
- Division of Diabetes, University of Texas Health Science Center at San Antonio. San Antonio, TX. US
- Diabetes and Obesity Clinical Research Center, Hamad General Hospital, Doha, Qatar
- Department of Clinical and Experimental Medicine. Section of Diabetes. University of Pisa. Pisa. Italy
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Iskandar S, Migahid A, Kamal D, Megahed O, DeFronzo RA, Zirie M, Jayyousi A, Al Jaidah M, Abdul-Ghani M. Glycated hemoglobin versus oral glucose tolerance test in the identification of subjects with prediabetes in Qatari population. BMC Endocr Disord 2019; 19:87. [PMID: 31438915 PMCID: PMC6704621 DOI: 10.1186/s12902-019-0412-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 07/19/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Subjects with prediabetes are at increased risk of future T2DM and cardiovascular disease (CVD) compared to NGT individuals. The OGTT (FPG = 100-125 and 2 h-PG = 140-199 mg/dl) and HbA1c 5.7-6.4% have been used to diagnose subjects with prediabetes. In the present study, we compared the ability of the OGTT and HbA1c to identify Qatari subjects with prediabetes. METHODS Four hundred forty six subjects without a history of T2DM received 75-g OGTT and measurement of HbA1c. The incidence of prediabetes in this cohort according to OGTT criteria was compared to that of HbA1c criteria. RESULTS The agreement between the OGTT and HbA1c in identifying subjects with prediabetes in Qatari subjects was poor, though significant (k = 015, p < 0.0001). Only 56% of participants had prediabetes or NGT according to OGTT and HbA1c. The disagreement between OGTT and HbA1c in diagnosing prediabetes was primarily due to low sensitivity of HbA1c. Moreover, subjects with prediabetes diagnosed with the OGTT have more severe metabolic profile than prediabetic subjects diagnosed with HbA1c. Lastly, more subjects with the metabolic syndrome were identified with OGTT (60%) criteria than with the HbA1c (49%), p < 0.0001. CONCLUSION These results demonstrate subjects with prediabetes diagnosed with OGTT have more severe metabolic risk than those diagnosed with HbA1c, and more likely to have greater risk of progression to T2DM.
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Affiliation(s)
| | - Ayman Migahid
- Academic Health System, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Dalia Kamal
- Academic Health System, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Osama Megahed
- Academic Health System, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Ralph A. DeFronzo
- Diabetes Division, University of Texas Health Science Center, San Antonio, TX USA
| | - Mahmoud Zirie
- Academic Health System, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Amin Jayyousi
- Academic Health System, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | | | - Muhammad Abdul-Ghani
- Academic Health System, Hamad General Hospital, PO Box 3050, Doha, Qatar
- Diabetes Division, University of Texas Health Science Center, San Antonio, TX USA
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Tripathy D, Merovci A, Basu R, Abdul-Ghani M, DeFronzo RA. Mild Physiologic Hyperglycemia Induces Hepatic Insulin Resistance in Healthy Normal Glucose-Tolerant Participants. J Clin Endocrinol Metab 2019; 104:2842-2850. [PMID: 30789980 PMCID: PMC6543508 DOI: 10.1210/jc.2018-02304] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/15/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT Chronic hyperglycemia worsens skeletal muscle insulin resistance and β-cell function. However, the effect of sustained physiologic hyperglycemia on hepatic insulin sensitivity is not clear. OBJECTIVE To examine the effect of sustained physiologic hyperglycemia (similar to that observed in patients with type 2 diabetes) on endogenous (primarily reflecting hepatic) glucose production (EGP) in healthy individuals. DESIGN Volunteers participated in a three-step hyperinsulinemic (10, 20, 40 mU/m2 per minute) euglycemic clamp before and after a 48-hour glucose infusion to increase plasma glucose concentration by ∼40 mg/dL above baseline. EGP was measured with 3-3H-glucose before and after chronic glucose infusion. PARTICIPANTS Sixteen persons with normal glucose tolerance [eight with and eight without a family history (FH) of diabetes] participated in the study. MAIN OUTCOME MEASURE EGP. RESULTS Basal EGP increased following 48 hours of glucose infusion (from a mean ± SEM of 2.04 ± 0.08 to 3.06 ± 0.29 mg/kgffm⋅ min; P < 0.005). The hepatic insulin resistance index (basal EGP × fasting plasma insulin) markedly increased following glucose infusion (20.1 ± 1.8 to 51.7 ± 6.6; P < 0.005) in both FH+ and FH- subjects. CONCLUSION Sustained physiologic hyperglycemia for as little as 48 hours increased the rate of basal hepatic glucose production and induced hepatic insulin resistance in health persons with normal glucose tolerance, providing evidence for the role of glucotoxicity in the increase in hepatic glucose production in type 2 diabetes.
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Affiliation(s)
- Devjit Tripathy
- Department of Medicine, Diabetes Division, University of Texas Health Science, San Antonio, Texas
- Audie L Murphy Veterans Affairs Hospital, South Texas Veterans Heath Care System, San Antonio, Texas
| | - Aurora Merovci
- Department of Medicine, Diabetes Division, University of Texas Health Science, San Antonio, Texas
| | - Rita Basu
- Department of Medicine, Endocrinology Division, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Muhammad Abdul-Ghani
- Department of Medicine, Diabetes Division, University of Texas Health Science, San Antonio, Texas
| | - Ralph A DeFronzo
- Department of Medicine, Diabetes Division, University of Texas Health Science, San Antonio, Texas
- Audie L Murphy Veterans Affairs Hospital, South Texas Veterans Heath Care System, San Antonio, Texas
- Correspondence and Reprint Requests: Ralph A. DeFronzo, MD, Diabetes Division, University of Texas Health Science, 7703 Floyd Curl Drive, San Antonio, Texas 78229. E-mail:
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Abdul-Ghani M, Migahid O, Megahed A, Singh R, Fawaz M, DeFronzo RA, Jayyousi A. Pioglitazone prevents the increase in plasma ketone concentration associated with dapagliflozin in insulin-treated T2DM patients: Results from the Qatar Study. Diabetes Obes Metab 2019; 21:705-709. [PMID: 30259621 DOI: 10.1111/dom.13546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/19/2018] [Accepted: 09/23/2018] [Indexed: 11/28/2022]
Abstract
Because of the unique mechanism of action of sodium-glucose co-transport inhibitors (SGLT2i), which is independent of insulin secretion and insulin action, members of this class of drugs effectively lower plasma glucose concentration when used in combination with all other antidiabetic agents, including insulin. Increased plasma ketone concentration has been reported in association with SGLT2i initiation, which, under certain clinical conditions, has developed into diabetic ketoacidosis. The daily insulin dose often is reduced at the time of initiating SGLT2i therapy in insulin-treated patients to avoid hypoglycaemia. However, reduction of insulin dose can increase the risk of ketoacidosis. In the present study, we examined the effect of the addition of dapagliflozin plus pioglitazone on plasma ketone concentration in insulin-treated T2DM patients and compared the results to the effect of dapagliflozin alone. A total of 18 poorly controlled, insulin-treated T2DM participants in the Qatar Study received dapagliflozin (10 mg) plus pioglitazone (30 mg), and 10 poorly controlled non-insulin-treated T2DM patients received dapagliflozin (10 mg) alone for 4 months. Dapagliflozin plus pioglitazone produced a robust decrease in HbA1c (-1.4%) and resulted in a 50% reduction in daily insulin dose, from 133 to 66 units, while dapagliflozin alone caused a 0.8% reduction in HbA1c. Dapagliflozin caused a four-fold increase in fasting plasma ketone concentration, while the combination of pioglitazone plus dapagliflozin was not associated with a significant increase (0.13 vs 0.15 mM) in plasma ketone concentration or in risk of hypoglycaemia. These results demonstrate that the addition of pioglitazone to dapagliflozin prevents the increase in plasma ketone concentration associated with SGLT2i therapy.
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Affiliation(s)
- Muhammad Abdul-Ghani
- Academic Health System, Hamad General Hospital, Doha, Qatar
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Osama Migahid
- Academic Health System, Hamad General Hospital, Doha, Qatar
| | - Ayman Megahed
- Academic Health System, Hamad General Hospital, Doha, Qatar
| | - Rajvir Singh
- Academic Health System, Hamad General Hospital, Doha, Qatar
| | - Mohammad Fawaz
- Academic Health System, Hamad General Hospital, Doha, Qatar
| | - Ralph A DeFronzo
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Amin Jayyousi
- Academic Health System, Hamad General Hospital, Doha, Qatar
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Abstract
Type 2 diabetes individuals are at high risk for macrovascular complications: myocardial infarction, stroke and cardiovascular mortality. Recent cardiovascular outcome trials have demonstrated that agents in two antidiabetic classes (SGLT2 inhibitors and GLP-1 receptor agonists) reduce major adverse cardiovascular events. However, there is strong evidence that an older and now generically available medication, the thiazolidinedione, pioglitazone, can retard the atherosclerotic process (PERISCOPE and Chicago) and reduce cardiovascular events in large randomized prospective cardiovascular outcome trials (IRIS and PROactive). Pioglitazone is a potent insulin sensitizer, preserves beta-cell function, causes durable reduction in HbA1c, corrects multiple components of metabolic syndrome and improves nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. Adverse effects (weight gain, fluid retention, fractures) must be considered, but are diminished with lower doses and are arguably outweighed by these multiple benefits. With healthcare expenses attributable to diabetes increasing rapidly, this cost-effective drug requires reconsideration in the therapeutic armamentarium for the disease.
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Affiliation(s)
- Ralph A DeFronzo
- 1 Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Silvio Inzucchi
- 2 Endocrine Division, Yale School of Medicine, New Haven, CT, USA
| | - Muhammad Abdul-Ghani
- 1 Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
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Alatrach M, Agyin C, Mehta R, Adams J, DeFronzo RA, Abdul-Ghani M. Glucose-Mediated Glucose Disposal at Baseline Insulin Is Impaired in IFG. J Clin Endocrinol Metab 2019; 104:163-171. [PMID: 30371795 PMCID: PMC6286408 DOI: 10.1210/jc.2017-01866] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/23/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To quantify glucose-mediated glucose disposal with and without basal insulin replacement and insulin-mediated glucose disposal in subjects with impaired fasting glucose (IFG). RESEARCH DESIGN AND METHODS We used the hyperglycemic/pancreatic clamp and stepped euglycemic clamp techniques to quantify glucose disposal and suppression of endogenous glucose production (EGP) in those with normal glucose tolerance (NGT; n = 14) and those with IFG (n = 14). RESULTS Total body glucose-mediated glucose uptake, measured with the hyperglycemic/pancreatic clamp, was not significantly affected by the basal plasma insulin levels in subjects with IFG and those with NGT. Compared with subjects with NGT, those with IFG had significantly lower glucose-mediated glucose uptake (by 15%) during the hyperglycemic clamp performed with and without basal insulin replacement. In contrast, insulin-mediated glucose disposal was comparable in both groups. The suppression of EGP by hyperglycemia was similar in both groups. However, the suppression of EGP by insulin was attenuated in those with IFG compared with those with NGT. CONCLUSIONS The results of the present study have demonstrated that (i) glucose-mediated glucose disposal is impaired in those with IFG; (ii) insulin-mediated glucose uptake in IFG is normal; and (iii) insulin action to suppress EGP is impaired.
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Affiliation(s)
- Mariam Alatrach
- Diabetes Division, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Christina Agyin
- Diabetes Division, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Rucha Mehta
- Diabetes Division, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - John Adams
- Diabetes Division, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ralph A DeFronzo
- Diabetes Division, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Muhammad Abdul-Ghani
- Diabetes Division, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Correspondence and Reprint Requests: Muhammad Abdul-Ghani, MD, PhD, Diabetes Division, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas 78229. E-mail:
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Shannon C, Merovci A, Xiong J, Tripathy D, Lorenzo F, McClain D, Abdul-Ghani M, Norton L, DeFronzo RA. Effect of Chronic Hyperglycemia on Glucose Metabolism in Subjects With Normal Glucose Tolerance. Diabetes 2018; 67:2507-2517. [PMID: 30213826 PMCID: PMC6245228 DOI: 10.2337/db18-0439] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022]
Abstract
Chronic hyperglycemia causes insulin resistance, but the inheritability of glucotoxicity and the underlying mechanisms are unclear. We examined the effect of 3 days of hyperglycemia on glucose disposal, enzyme activities, insulin signaling, and protein O-GlcNAcylation in skeletal muscle of individuals without (FH-) or with (FH+) family history of type 2 diabetes. Twenty-five subjects with normal glucose tolerance received a [3-3H]glucose euglycemic insulin clamp, indirect calorimetry, and vastus-lateralis biopsies before and after 3 days of saline (n = 5) or glucose (n = 10 FH- and 10 FH+) infusion to raise plasma glucose by ∼45 mg/dL. At baseline, FH+ had lower insulin-stimulated glucose oxidation and total glucose disposal (TGD) but similar nonoxidative glucose disposal and basal endogenous glucose production (bEGP) compared with FH- After 3 days of glucose infusion, bEGP and glucose oxidation were markedly increased, whereas nonoxidative glucose disposal and TGD were lower versus baseline, with no differences between FH- and FH+ subjects. Hyperglycemia doubled skeletal muscle glycogen content and impaired activation of glycogen synthase (GS), pyruvate dehydrogenase, and Akt, but protein O-GlcNAcylation was unchanged. Insulin resistance develops to a similar extent in FH- and FH+ subjects after chronic hyperglycemia, without increased protein O-GlcNAcylation. Decreased nonoxidative glucose disposal due to impaired GS activation appears to be the primary deficit in skeletal muscle glucotoxicity.
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Affiliation(s)
- Chris Shannon
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
| | - Aurora Merovci
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
| | - Juan Xiong
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
| | - Devjit Tripathy
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
| | - Felipe Lorenzo
- Center on Diabetes, Obesity, and Metabolism, Wake Forest University, Winston-Salem, NC
| | - Donald McClain
- Center on Diabetes, Obesity, and Metabolism, Wake Forest University, Winston-Salem, NC
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
| | - Luke Norton
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
| | - Ralph A DeFronzo
- Division of Diabetes, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX
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Abdul-Ghani M, DeFronzo R. Therapeutic strategies for type 2 diabetes mellitus patients with very high HbA1c: is insulin the only option? Ann Transl Med 2018; 6:S95-S95. [PMID: 30740416 PMCID: PMC6330628 DOI: 10.21037/atm.2018.11.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
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Bergman M, Manco M, Sesti G, Dankner R, Pareek M, Jagannathan R, Chetrit A, Abdul-Ghani M, Buysschaert M, Olsen MH, Nilsson PM, Medina JL, Roth J, Groop L, Del Prato S, Raz I, Ceriello A. Petition to replace current OGTT criteria for diagnosing prediabetes with the 1-hour post-load plasma glucose ≥ 155 mg/dl (8.6 mmol/L). Diabetes Res Clin Pract 2018; 146:18-33. [PMID: 30273707 DOI: 10.1016/j.diabres.2018.09.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 02/08/2023]
Abstract
Many individuals with prediabetes, as presently defined, will progress to diabetes (T2D) despite the considerable benefit of lifestyle modification. Therefore, it is paramount to screen individuals at increased risk with a more sensitive method capable of identifying prediabetes at an even earlier time point in the lengthy trajectory to T2D. This petition reviews findings demonstrating that the 1-hour (1-h) postload plasma glucose (PG) ≥ 155 mg/dl (8.6 mmol/L) in those with normal glucose tolerance (NGT) during an oral glucose tolerance test (OGTT) is highly predictive for detecting progression to T2D, micro- and macrovascular complications and mortality in individuals at increased risk. Furthermore, the STOP DIABETES Study documented effective interventions that reduce the future risk of T2D in those with NGT and a 1-h PG ≥ 155 mg/dl (8·6 mmol/L). The 1-h OGTT represents a valuable opportunity to extend the proven benefit of diabetes prevention to the sizeable and growing population of individuals at increased risk of progression to T2D. The substantial evidence provided in this petition strongly supports redefining current diagnostic criteria for prediabetes with the elevated 1-h PG level. The authors therefore advocate a 1-h OGTT to detect prediabetes and hence, thwart the global diabetes epidemic.
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Affiliation(s)
- Michael Bergman
- NYU School of Medicine, Department of Medicine and of Population Health, Division of Endocrinology and Metabolism, NYU Langone Diabetes Prevention Program, New York, NY, USA.
| | - Melania Manco
- Research Unit for Multifactorial Diseases and Complex Phenotypes, Bambino Gesù Children Hospital, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Rachel Dankner
- The Feinstein Institute for Medical Research, Manhasset, North Shore, NY, USA; Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Manan Pareek
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Denmark; Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Ram Jagannathan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 18, Atlanta, GA, USA
| | - Angela Chetrit
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Martin Buysschaert
- Department of Endocrinology and Diabetology, Université Catholique de Louvain, University, Clinic Saint-Luc, Brussels, Belgium
| | - Michael H Olsen
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Denmark; Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Peter M Nilsson
- Department of Clinical Sciences and Lund University Diabetes Centre, Lund University, Skåne University Hospital, Malmö, Sweden
| | | | - Jesse Roth
- The Feinstein Institute for Medical Research, Manhasset, North Shore, NY, USA
| | - Leif Groop
- Lund University, Lund University Diabetes Centre, Malmö, Sweden
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Itamar Raz
- Diabetes Unit at Hadassah University Hospital, Hadassah Center for the Prevention of Diabetes, Diabetes Clinical Research Center, Jerusalem, Israel
| | - Antonio Ceriello
- Institut d'Investigacions Biomèdiques August Pi I Sunyer and Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Barcelona, Spain; Department of Cardiovascular and Metabolic Diseases, Istituto Ricerca Cura Carattere Scientifico Multimedica, Sesto, San Giovanni, MI, Italy
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Armato JP, DeFronzo RA, Abdul-Ghani M, Ruby RJ. Successful treatment of prediabetes in clinical practice using physiological assessment (STOP DIABETES). Lancet Diabetes Endocrinol 2018; 6:781-789. [PMID: 30224284 DOI: 10.1016/s2213-8587(18)30234-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Of the 84 million American adults with prediabetes, over 5 to 7 years, about 28 million progress to type 2 diabetes. We aimed to assess whether a real-world, pathophysiology-based, therapeutic approach could prevent development of type 2 diabetes in high-risk individuals. METHODS We did a retrospective observational study of people at increased risk of type 2 diabetes from a community practice in southern California, USA. Participants had an oral glucose tolerance test and were assigned a risk stratification on the basis of presence and severity of insulin resistance, impaired β-cell function, and glycaemia (ie, 1-h plasma glucose concentration of more than 8·6 mmol/L during an oral glucose tolerance test). Treatment was recommended on the basis of risk: metformin, pioglitazone, glucagon-like peptide-1 (GLP-1) receptor agonist, and lifestyle therapy for participants at high risk of diabetes, and metformin, pioglitazone, and lifestyle therapy for those at intermediate risk. Individuals who refused pharmacological therapy were assigned to lifestyle therapy only. Participants were followed up every 6 months and oral glucose tolerance tests were repeated at 6 months and subsequently every 2 years or sooner. The primary outcome of our analysis was incidence of type 2 diabetes according to the American Diabetes Association criteria, within the study period (2009-16). This study is registered with ClinicalTrials.gov, number NCT03308773. FINDINGS Between Jan 1, 2009 and Dec 31, 2016, we assessed 1769 people at increased risk of diabetes, of which 747 (42%) were identified at high or intermediate risk and were recommended pharmacological treatment. Of 422 participants analysed, 28 (7%) progressed to type 2 diabetes (seven [5%] of 141 participants who received metformin, pioglitazone, and lifestyle therapy, none [0%] of 81 who received metformin, pioglitazone, GLP-1 receptor agonist, and lifestyle therapy, and 21 [11%] of 200 who received lifestyle therapy only) after mean follow-up of 32·09 months (SEM 1·24). Compared with participants who received lifestyle therapy only, the adjusted hazard ratio for progression to type 2 diabetes was 0·29 (95% CI 0·11-0·78, p=0·0009) in participants who received metformin and pioglitazone, and 0·12 (95% CI 0·02-0·94, p=0·04) in participants who received metformin, pioglitazone, and GLP-1 receptor agonist. Improved β-cell function was the strongest predictor of type 2 diabetes prevention. INTERPRETATION Progression to type 2 diabetes in people at high risk of diabetes can be markedly reduced with interventions designed to correct underlying pathophysiological disturbances (ie, impaired insulin secretion and resistance) in a real-world setting. FUNDING None.
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Affiliation(s)
- John P Armato
- Providence Little Company of Mary Cardiometabolic Center, Torrance, CA, USA.
| | - Ralph A DeFronzo
- Diabetes Division, University of Texas Health Science Center, San Antonio, TX, USA
| | - Muhammad Abdul-Ghani
- Diabetes Division, University of Texas Health Science Center, San Antonio, TX, USA
| | - Ron J Ruby
- Providence Little Company of Mary Cardiometabolic Center, Torrance, CA, USA.
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Ripley EM, Clarke GD, Hamidi V, Martinez RA, Settles FD, Solis C, Deng S, Abdul-Ghani M, Tripathy D, DeFronzo RA. Reduced skeletal muscle phosphocreatine concentration in type 2 diabetic patients: a quantitative image-based phosphorus-31 MR spectroscopy study. Am J Physiol Endocrinol Metab 2018; 315:E229-E239. [PMID: 29509433 PMCID: PMC6139498 DOI: 10.1152/ajpendo.00426.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mitochondrial function has been examined in insulin-resistant (IR) states including type 2 diabetes mellitus (T2DM). Previous studies using phosphorus-31 magnetic resonance spectroscopy (31P-MRS) in T2DM reported results as relative concentrations of metabolite ratios, which could obscure differences in phosphocreatine ([PCr]) and adenosine triphosphate concentrations ([ATP]) between T2DM and normal glucose tolerance (NGT) individuals. We used an image-guided 31P-MRS method to quantitate [PCr], inorganic phosphate [Pi], phosphodiester [PDE], and [ATP] in vastus lateralis (VL) muscle in 11 T2DM and 14 NGT subjects. Subjects also received oral glucose tolerance test, euglycemic insulin clamp, 1H-MRS to measure intramyocellular lipids [IMCL], and VL muscle biopsy to evaluate mitochondrial density. T2DM subjects had lower absolute [PCr] and [ATP] than NGT subjects (PCr 28.6 ± 3.2 vs. 24.6 ± 2.4, P < 0.002, and ATP 7.18 ± 0.6 vs. 6.37 ± 1.1, P < 0.02) while [PDE] was higher, but not significantly. [PCr], obtained using the traditional ratio method, showed no significant difference between groups. [PCr] was negatively correlated with HbA1c ( r = -0.63, P < 0.01) and fasting plasma glucose ( r = -0.51, P = 0.01). [PDE] was negatively correlated with Matsuda index ( r = -0.43, P = 0.03) and M/I ( r = -0.46, P = 0.04), but was positively correlated with [IMCL] ( r = 0.64, P < 0.005), HbA1c, and FPG ( r = 0.60, P = 0.001). To summarize, using a modified, in vivo quantitative 31P-MRS method, skeletal muscle [PCr] and [ATP] are reduced in T2DM, while this difference was not observed with the traditional ratio method. The strong inverse correlation between [PCr] vs. HbA1c, FPG, and insulin sensitivity supports the concept that lower baseline skeletal muscle [PCr] is related to key determinants of glucose homeostasis.
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Affiliation(s)
- Erika M Ripley
- Department of Radiology, University of Texas Health Science Center at San Antonio , San Antonio, Texas
| | - Geoffrey D Clarke
- Department of Radiology, University of Texas Health Science Center at San Antonio , San Antonio, Texas
- Diabetes Division, University of Texas Health Science Center at San Antonio , San Antonio, Texas
- Research Imaging Institute, University of Texas Health Science Center at San Antonio , San Antonio, Texas
| | - Vala Hamidi
- Diabetes Division, University of Texas Health Science Center at San Antonio , San Antonio, Texas
| | - Robert A Martinez
- Diabetes Division, University of Texas Health Science Center at San Antonio , San Antonio, Texas
| | - Floyd D Settles
- Department of Radiology, University of Texas Health Science Center at San Antonio , San Antonio, Texas
| | - Carolina Solis
- Diabetes Division, University of Texas Health Science Center at San Antonio , San Antonio, Texas
| | - Shengwen Deng
- Research Imaging Institute, University of Texas Health Science Center at San Antonio , San Antonio, Texas
| | - Muhammad Abdul-Ghani
- Diabetes Division, University of Texas Health Science Center at San Antonio , San Antonio, Texas
| | - Devjit Tripathy
- Diabetes Division, University of Texas Health Science Center at San Antonio , San Antonio, Texas
| | - Ralph A DeFronzo
- Diabetes Division, University of Texas Health Science Center at San Antonio , San Antonio, Texas
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Bener A, Eliaçık M, Cincik H, Öztürk M, DeFronzo RA, Abdul-Ghani M. The Impact of Vitamin D Deficiency on Retinopathy and Hearing Loss among Type 2 Diabetic Patients. Biomed Res Int 2018; 2018:2714590. [PMID: 30112372 PMCID: PMC6077590 DOI: 10.1155/2018/2714590] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/07/2018] [Indexed: 12/22/2022]
Abstract
AIM The current study was aiming to investigate the relation between vitamin D, retinopathy, and hearing loss among type 2 diabetes mellitus (T2DM) patients. METHODS Cross-sectional study carried on 638 subjects aged between 20 and 60 years who visited the Endocrinology, Ophthalmology, and ENT Outpatient Clinics of the Medipol Hospital during the period from March 2016 to May 2017. Two audiometers Grason Stadler GSI 61 and Interacoustics AC40 Clinical audiometer were used to evaluate the hearing loss. Risk factors for diabetic retinopathy were evaluated, including age, sex, diabetes duration, glycated hemoglobin (HbA1c), hypertension, and lipid profiles. RESULTS The mean age (± SD, in years) for retinopathy with hearing loss versus normal subjects was 47.7 ±10.2 versus 48.5±9.1. The associated risk factors were significantly higher in T2DM with hearing loss, hypertension (32.6% versus 15.7%), tinnitus (40.0% versus 18.0%), vertigo (59.7% versus 26.8%), and headache (54.9% versus 45.3%), than in normal hearing diabetes. There were statistically significant differences between hearing impairment versus normal hearing for vitamin D [19.40±9.71 ng/ml versus 22.67±9.28 ng/ml; p<0.001], calcium, magnesium, phosphorous, cholesterol, HDL-C, LDL-C, albumin, systolic blood pressure [131.70±9.25 Hg versus 127.73±11.98 Hg], diastolic blood pressure [82.20±8.60 mm Hg versus 79.80±8.20 mm Hg], and microalbuminuria. Multivariate logistic regression analysis revealed that variables such as vertigo, duration of DM, mobile/I pad phone, vitamin D deficiency, sleeping disturbance, headache, frequently TV watching, tinnitus, cigarette smokers, and hypertension were considered at higher risk as a predictors of retinopathy with hearing loss among diabetic patients. CONCLUSION Vitamin D deficiency is considered as a risk factor for diabetic retinopathy and hearing loss among diabetic patients. Meanwhile, hyperglycemia could be considered as a modifiable risk factor for diabetic retinopathy; tight glycemic control may be the most effective and important therapy for improving quality of life and substantially reducing the incidence of retinopathy and in T2DM patients.
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Affiliation(s)
- Abdulbari Bener
- Department of Biostatistics & Medical Informatics, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, The University of Manchester, Manchester, UK
- Department of Endocrinology, Medipol International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mustafa Eliaçık
- Department of Ophthalmology, Medipol International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Hakan Cincik
- Department of ENT and Audiology, Medipol International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mustafa Öztürk
- Department of Endocrinology, Medipol International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ralph A. DeFronzo
- Division of Diabetes, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
- Academic Health System, Hamad General Hospital, Doha, Qatar
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Martinez R, Al-Jobori H, Ali AM, Adams J, Abdul-Ghani M, Triplitt C, DeFronzo RA, Cersosimo E. Endogenous Glucose Production and Hormonal Changes in Response to Canagliflozin and Liraglutide Combination Therapy. Diabetes 2018; 67:1182-1189. [PMID: 29602791 PMCID: PMC7301339 DOI: 10.2337/db17-1278] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 03/27/2018] [Indexed: 12/13/2022]
Abstract
The decrement in plasma glucose concentration with SGLT2 inhibitors (SGLT2i) is blunted by a rise in endogenous glucose production (EGP). We investigated the ability of incretin treatment to offset the EGP increase. Subjects with type 2 diabetes (n = 36) were randomized to 1) canagliflozin (CANA), 2) liraglutide (LIRA), or 3) CANA plus LIRA (CANA/LIRA). EGP was measured with [3-3H]glucose with or without drugs for 360 min. In the pretreatment studies, EGP was comparable and decreased (2.2 ± 0.1 to 1.7 ± 0.2 mg/kg ⋅ min) during a 300- to 360-min period (P < 0.01). The decrement in EGP was attenuated with CANA (2.1 ± 0.1 to 1.9 ± 0.1 mg/kg ⋅ min) and CANA/LIRA (2.2 ± 0.1 to 2.0 ± 0.1 mg/kg ⋅ min), whereas with LIRA it was the same (2.4 ± 0.2 to 1.8 ± 0.2 mg/kg ⋅ min) (all P < 0.05 vs. baseline). After CANA, the fasting plasma insulin concentration decreased (18 ± 2 to 12 ± 2 μU/mL, P < 0.05), while it remained unchanged in LIRA (18 ± 2 vs. 16 ± 2 μU/mL) and CANA/LIRA (17 ± 1 vs. 15 ± 2 μU/mL). Mean plasma glucagon did not change during the pretreatment studies from 0 to 360 min, while it increased with CANA (69 ± 3 to 78 ± 2 pg/mL, P < 0.05), decreased with LIRA (93 ± 6 to 80 ± 6 pg/mL, P < 0.05), and did not change in CANA/LIRA. LIRA prevented the insulin decline and blocked the glucagon rise observed with CANA but did not inhibit the increase in EGP. Factors other than insulin and glucagon contribute to the stimulation of EGP after CANA-induced glucosuria.
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Affiliation(s)
- Robert Martinez
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center and Texas Diabetes Institute, University Health System, San Antonio, TX
| | - Hussein Al-Jobori
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center and Texas Diabetes Institute, University Health System, San Antonio, TX
| | - Ali M Ali
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center and Texas Diabetes Institute, University Health System, San Antonio, TX
| | - John Adams
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center and Texas Diabetes Institute, University Health System, San Antonio, TX
| | - Muhammad Abdul-Ghani
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center and Texas Diabetes Institute, University Health System, San Antonio, TX
| | - Curtis Triplitt
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center and Texas Diabetes Institute, University Health System, San Antonio, TX
| | - Ralph A DeFronzo
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center and Texas Diabetes Institute, University Health System, San Antonio, TX
| | - Eugenio Cersosimo
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center and Texas Diabetes Institute, University Health System, San Antonio, TX
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Abdul-Ghani M, Jayyous A, Asaad N, Helmy S, Al-Suwaidi J. Pioglitazone and cardiovascular risk in T2DM patients: is it good for all? Ann Transl Med 2018; 6:192. [PMID: 29951514 DOI: 10.21037/atm.2018.03.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | - Amin Jayyous
- Academic Health System, Hamad General Hospital, Doha, Qatar
| | - Nidal Asaad
- Cardio-Metabolic Institute, Hamad General Hospital, Doha, Qatar
| | - Sherif Helmy
- Cardio-Metabolic Institute, Hamad General Hospital, Doha, Qatar
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